Clinical effects of incretins and the limits of gerotherapy
Incretin drugs have set a benchmark for future aging therapies in Asia
On August 31, BioPharma APAC published an analysis of how the widespread use of incretin drugs is changing the goals of future aging therapies. Incretins act on hormonal signals that regulate blood glucose and appetite, and they are used to treat diabetes and obesity.
Semaglutide and tirzepatide were initially prescribed for diabetes and obesity. They were tested in trials with outcomes that matter to patients and approved for specific diagnoses. The essay argues that developers of aging therapies need to answer the same questions: who should receive the treatment, which patient outcome it improves, and why healthcare systems should pay for it.
The SELECT trial shows the standard that these therapies will need to meet. The trial randomly assigned 17 604 people over 45 years of age who had cardiovascular disease and overweight or obesity, but did not have diabetes, to receive semaglutide or placebo. Over a mean follow-up of 39,8 months, 6,5% of participants receiving semaglutide experienced at least one of three outcomes: death from a cardiovascular cause, nonfatal myocardial infarction, or nonfatal stroke. The corresponding proportion in the placebo group was 8,0%. These results provide a basis for discussing the prescription and reimbursement of a specific drug for a defined patient group.
In India, this benchmark also has a price. The semaglutide patent expired there on March 20, and locally produced versions entered the market on March 21. A Sun Pharma press release gives the monthly cost of treatment as approximately 900–2 000 rupees for the weight management drug and 750–1 300 rupees for the diabetes drug. The essay argues that developers of preventive therapies will need to compare their prices and outcomes with those of this already available treatment.
The author identifies body composition as a separate target for treatments combined with incretin therapy. In the initial data on the drug candidate ATX-304, Cambrian reported changes in metabolic measures in 23 people. Preservation of lean mass in combination with semaglutide has so far been demonstrated only in mice. Lean mass includes muscle, bone, organs, and other body tissues. Developers of muscle-preserving treatments need to show when a change in body composition becomes meaningful to patients and how it should be measured in a trial.
Aging therapies will be evaluated by whether their benefits can be measured in a trial, approved for a defined group of people, and reimbursed within a healthcare system.