The obesity revolution is here

Whether in Hollywood, on Wall Street, or in doctors' offices around the country, the arrival of a powerful new class of weight-loss drugs has changed the conversation about obesity in the U.S. And the most dramatic effects are yet to come.

As STAT's Elaine Chen and Matthew Herper report, history has shown that new blockbuster drugs can alter how people think about health. Valium changed society's views on anxiety in the 1960s and Prozac on depression in the '80s. People worried about their cholesterol a lot more after ads for Zocor ended up on NFL games.

Now, the new obesity drugs are hitting the market, heating up one of the biggest pharmaceutical competitions in history and raising profound questions of cost, equity, and cultural bias. And like previous blockbusters, these drugs may also end up changing how people think about what it means to be sick and what it takes to be healthy.

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Biotech

Novel drug for the cause of dwarfism shows promise

A BridgeBio treatment for the most common cause of dwarfism accelerated children's growth in a small but closely watched clinical trial, the company said today, advancing the latest treatment in what has been a polarizing field of study.

The drug, a pill called infigratinib, increased the pace of growth by about 3 centimeters per year from baseline for a cohort of 10 children with achondroplasia, a rare genetic disorder that results in dwarfism and can lead to serious medical complications. That's roughly double the observed benefit of Voxzogo, an injectable medicine from BioMarin Pharmaceutical that became the first approved achondroplasia treatment in 2021.

The next step for BridgeBio is a one-year, Phase 3 study that would support Food and Drug Administration approval for infigratinib. If the drug can outperform BioMarin's treatment in a larger trial, the convenience of an oral treatment over a daily injection could turn infigratinib into a $1 billion product at its commercial peak, according to analyst estimates.

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Cardiology

Esperion's drug worked. Now what?

Esperion Therapeutics' cholesterol-lowering drug reduced the rate of heart attacks and death in a large trial, affirming the company's 15-year effort to establish its medicine as a viable alternative to statin therapy. But whether the company has a commercial future remains to be seen.

As STAT's Matthew Herper reports, the company's pill, Nexletol, reduced the rate of heart attacks, strokes, coronary procedures to put in stents, and death from cardiovascular causes by 13% compared to placebo. That means in patients who received placebo, these events occurred in 13.3% of patients over a period of about three years. For those who received Nexletol, the number was 11.7%.

The results "will and should" increase the use of Nexletol for patients at a high risk for heart attacks who are "unable or unwilling" to take statins, Duke University cardiologist John Alexander wrote in a New England Journal of Medicine editorial. But whether that will rescue Esperion, which has lost more than 90% of its value since 2020, is hardly guaranteed.

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Drug prices

How Lilly is saving money by slashing prices

Eli Lilly's decision to dramatically reduce the prices of its older insulin products won some favorable coverage and shunted scrutiny over to its foes in the world of pharmacy benefits management. But it also saved the company from having to pay sizable penalties to the federal government.

As STAT's John Wilkerson reports, Lilly would have been charged about $150 for each vial of insulin used by Medicaid if it hadn't slashed its prices. Under a law signed in 2021, companies that raise the prices of their medicines faster than the rate of inflation have to pay Medicaid back for the difference.

In the past, those rebates have been capped at the price of a drug, meaning Medicaid has been getting Humalog, one of Lilly's insulin products, for free. But thanks to the American Rescue Plan, those caps go away starting in 2024, at which point Lilly would have to pay Medicaid to take its medicine.

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