Approximately 21 people for every 1000 in the state of Kentucky have been prescribed a 

from the short list of very popular antiobesity and 

 drugs (T2D), according to reporting on Axios. That is the highest rate of any state in the country and based on insurance claims data collected by PurpleLab, a health analytics company.

Louisiana and Mississippi are among the handful of other southern states with the highest prescribing rates for the most well known drugs in the category - Ozempic and Wegovy (

; Novo Nordisk). The data also include prescriptions written for Mounjaro (T2D) and Zepbound (weight management), both from Eli Lilly and containing the GLP-1 RA 

Data from the CDC indicate that the higher prescribing patterns in these states align with the greater prevalence of both diseases in the US south.

Axios reporters point out that because the data aggregate prescriptions, it's not possible to discern how often the drugs were prescribed for obesity vs for T2D. Nor does the analysis account for how long individuals took the medications. Reed also adds a note on celebrity promotion of weight loss using the medications noting that if "it seems that California's prescribing rate is lower than expected, the data doesn't pick up prescriptions that were paid for in cash." More on the Axios report, 

Source: Reed T. United States of Ozempic: Where anti-obesity drugs are taking off. Axios Vitals. January 18, 2024. Accessed January 19, 2024. https://www.axios.com/2024/01/18/ozempic-wegovy-weight-loss-drugs-states-map

Slideshows

The GLP-1 RAs Wegovy, Ozempic, Mounjaro, and Zepbound have taken up more real estate on the US map in some areas than others. Click to find out more. 

Where is All the Wegovy Going? Highest and Lowest Prescribing States 

Semaglutide was associated with a lower risk of first-time and recurrent suicidal ideations in patients with obesity or overweight or 

 (T2D), according to data from a recent retrospective analysis of the 2 patient populations.

 showed that among 240 618 participants who were obese or overweight, those taking 

 had a significantly lower risk of suicidal ideation compared with those who received non-glucagon-like peptide 1 receptor (GLP1R) agonist antiobesity medications (0.11% vs 0.43%; hazard ratio [HR] 0.27, 95% CI 0.20-0.36).

Similarly, in the second cohort of 1 589 855 patients with T2D, results showed that the semaglutide group had a significantly lower risk for incident suicidal ideation than the matched non-GLP1R agonist antiobesity medication group (0.13% vs 0.36%; HR 0.36, 95% CI 0.25-0.53), according to corresponding author Nora Volkow, MD, director, National Institute on Drug Abuse, and colleagues.

“Previous concerns raised by case reports associating semaglutide with suicidal ideations has led to an investigation by the European Medicines Agency,” wrote researchers in separate research briefing on the study. “In contrast to these case reports, this cohort study found that semaglutide did not further increase the risk of suicidal ideations compared with other weight loss or anti-diabetes medications. This study contributes to the evidence base regarding safety profiles of real-world semaglutide use.”

For the current study, Volkow and colleagues used US electronic health records from the TriNetX Analytics Network. They followed participants for 6 months to examine the first incidence and relapse of suicidal ideations, according to the study.

The first cohort consisted of 240 628 patients with 

 or overweight (mean age, 50.1 years, 72.6% women, 16% Black) and were prescribed semaglutide or non-GLP1R agonist antiobesity medications from June 2021 through December 2022. Among the cohort, 232 771 individuals did not have a history of suicidal ideation and 7847 did.

In the second analysis, investigators replicated the original investigation with 1 589 855 patients with T2D (mean age, 57.5 years, 49.2% women, 15.4% Black) who were prescribed semaglutide or non-GLP1R antidiabetes medications from December 2017 through May 2021. Among this cohort, 1 572 885 participants did not have a prior history of suicidal ideation and 16 970 did.

Patients in both cohorts were matched for demographic characteristics, medical history, lifestyle issues, mental and substance use disorders, and prior suicidal ideation and behavior, according to researchers.

In addition to the findings on incident suicidal ideations as mentioned previously, results showed similar data on the association between semaglutide and the risk of recurrent suicidal ideation. Patients with obesity or overweight who received semaglutide had a significantly lower risk of recurrent suicidal ideation compared with those taking other non-GLP1R agonist obesity medications (6.5% vs 14.1%; HR 0.44, 95% CI 0.32-0.60).

“Further studies should evaluate the association of semaglutide and other GLP1R agonist medications with the incidence and recurrence of suicidality in other at-risk populations,” concluded Volkow et al.

Association of semaglutide with risk of suicidal ideation in a real-world cohort

. Published online January 5, 2024. doi:10.1038/s41591-023-02672-2

Semaglutide and risk of suicidal ideations

. Published online January 5, 2024. doi:10.1038/s41591-023-02691-z

Articles

Semaglutide was associated with a lower risk of first-time and recurrent suicidal ideations in patients with obesity or overweight or T2D, according to new study.

Semaglutide Linked to Lower Risk of Suicidal Ideation in Patients with Obesity, Type 2 Diabetes

“Lilly stands against use of its medicines for cosmetic weight loss,” 

the company stated in an open letter to the public released online late Thursday afternoon referring to the 2 formulations of its dual incretin mimetic tirzepatide, marketed as Zepbound for chronic 

 and as Mounjaro to reduce hyperglycemia in persons with 

The drugs “are indicated for the treatment of serious diseases; they are not approved for – and should not be used for – cosmetic weight loss,” the statement continued. “Lilly does not promote or encourage use of Mounjaro, Zepbound, or any Lilly medicines outside of a medicine’s FDA-approved indication.”

The company detailed the indications specified in the approved FDA labeling for both drugs and also warned the public about the circulation of counterfeit and compounded tirzepatide.

“Patient safety is Lilly’s top priority, and we actively engage in monitoring, evaluating and reporting safety information for all our medicines,” the letter stated. “We are aware of certain practices relating to our tirzepatide medicines that we wish to address publicly to ensure that our medicines are prescribed and used safely.”

 as an adjunct to diet and exercise to improve glucose control in adults with type 2 diabetes, in May 2022, as Mounjaro, and for 

in addition to a reduced-calorie diet and increased physical activity among adults with obesity or overweight with one weight-related comorbidity (eg, hypertension, what else), in November 2023.

The 2 Lilly drugs entered both medical and consumer markets primed by previous FDA approvals of the Novo Nordisk incretin mimetic semaglutide for the same 2 diseases. Semaglutide for adults with T2D is marketed as Ozempic and for adults and with overweight or obesity as Wegovy. Initial reports of the significant weight loss that accompanied improvement in symptoms of T2D with Ozempic triggered an outsized media response that continues around all 4 drugs, driving off-label prescribing for cosmetic weight loss and nationwide shortages, making it more difficult for those with both diseases to obtain them.

The demand, driven in large part by viral online promotion by celebrities and social media influencers, has also led to an illegal market of counterfeit products including potentially dangerous formulations prepared by compounding pharmacies. The company states it has found “high amounts of impurities” in compounded tirzepatide samples it has tested including one instance where the product was “nothing more than sugar alcohol.” “Tirzepatide products not manufactured by Lilly may expose patients to potentially serious health risks,” the letter warned.

The company also said it is currently engaged in legal action against actors including medical spas, wellness centers, and compounding pharmacies making or selling products that claim to contain the active ingredient for tirzepatide as well as against organizations that import or distribute the products.

Lilly’s concern follows by less than a month an FDA drug safety alert about reports of adverse events following use of compounded semaglutide (Ozempic, Wegovy), a communication that reviews previous steps FDA had taken on the matter in April and October 2023.

The Lilly letter urges anyone who suspects they may have purchased or used counterfeit or compounded tirzepatide to contact their health care professional to discuss further action.

The company advises health care professionals to review the Instructions for Use for both Mounjaro and Zepbound and consider carefully the information on risks associated with tirzepatide detailed in the Full Prescribing Information and Medication Guide for both products. The drugs should only be prescribed by a licensed health care professional and use should be discussed in a clinician-patient consultation to determine the patient’s eligibility for either formulation. The letter also cautions that Mounjaro and Zepbound have not been evaluated in individuals with severe gastrointestinal disease, including severe gastroparesis, and so should not be recommended for same.

 for Mounjaro. Please click to access the full 

If a healthcare provider has questions about the use of Lilly’s tirzepatide medicines, they are encouraged to chat directly with a Lilly Medical Professional 

 or contact Lilly at 1-800-LillyRx (1-800-545-5979).

Patients and healthcare providers are encouraged to report counterfeit (“fake”) Mounjaro and Zepbound products to the Lilly Answers Center (TLAC) at 1-800-LillyRx (1-800-545-5979).

1. Open letter regarding the use of Mounjaro (tirzepatide) and Zepbound (tirzepatide). News release. Lilly. January 4, 2024. Accessed January 4, 2024. https://investor.lilly.com/news-releases/news-release-details/open-letter-regarding-use-mounjaror-tirzepatide-and-zepboundtm

2. Medications containing semaglutide marketed for type 2 diabetes or weight loss. News release. US Food and drug Administration. December 21, 2023. Accessed January 5, 2023. 

https://www.fda.gov/drugs/postmarket-drug-safety-information-patients-and-providers/medications-containing-semaglutide-marketed-type-2-diabetes-or-weight-loss

In an open letter to the public, Lilly decries use of tirzepatide products Mounjaro and Zepbound for nonmedical purposes and warns of counterfeit formulations.  

Eli Lilly Open Letter Warns Against Use of Tirzepatide for "Cosmetic Weight Loss" 

Digital Edition for Patient Care Online for March, 2024

Patient Care Online March 2024 | Patient Care Digital Edition

Where is All the Wegovy Going? Highest and Lowest Prescribing States

Semaglutide Linked to Lower Risk of Suicidal Ideation in Patients with Obesity, Type 2 Diabetes

Eli Lilly Open Letter Warns Against Use of Tirzepatide for "Cosmetic Weight Loss"