Shots:
- Did you know that coronary stent usage can decline by 20 percent if GLP-1 therapy is used as widely as statin therapy?
- PharmaShots welcomes Saif Rathore, Founder of Sandbar Life Sciences and Entrepreneur-in-Residence at Yale Ventures, and Andrew Epstein, Principal at Medicus Economics, for an illuminating dialogue exchange
- Saif and Andrew highlight the untapped potential of GLP-1 therapy in cardiovascular procedures
Saurabh: Please shed some light on how GLP-1 therapies are impacting cardiovascular procedures.
Saif & Andrew: The SELECT randomized trial showed that GLP-1 therapy can reduce the need for coronary revascularization over five years of follow-up. We’re still early in the adoption curve for newer GLP-1s, so we don’t see a drop-off yet. But we expect that the next couple of years will begin to show reductions in cardiovascular procedures as more patients spend more time on therapy. We focused specifically on coronary stents, but we expect that this will impact other cardiovascular therapies treating conditions in which obesity is a driver, like aortic stenosis, abdominal aortic aneurysm, and peripheral interventions. And, we expect the benefits from GLP-1s will increase as newer agents in the class become available with more-favorable efficacy and side effect profiles
Saurabh: The study mentions a 20% drop off in coronary stents with the gaining popularity of GLP-1 therapy. Do the trends favor the use of GLP-1 at the statins level and how likely is it to impact the adoption patterns globally?
Saif & Andrew: Each day we see more evidence of the benefit of GLP-1s in areas that go beyond current indications, ranging from polycystic ovarian syndrome to substance abuse disorders, so we certainly believe there is a broad interest in these therapies. They’re truly distinctive. Physicians prescribe statins to manage cardiovascular risk, but patients don’t see those direct benefits. Physicians will prescribe GLP-1s for the same reason, but GLP-1s are a therapy you see patients asking for as well – recognizing that they will see tangible benefits with weight loss. This aligned motivation is unusual and we believe will drive GLP-1 adoption to a level akin to statins.
Saurabh: With an acute shortage of GLP-1 medications in indications such as chronic weight and diabetes management, how challenging would it be for CMS to meet the growing supply demands owing to the increasing prevalence of cardiovascular and diabetes events?
Saif & Andrew: Supply challenges for GLP-1s are being resolved and we don’t foresee them being an issue past next year. First, Novo Nordisk and Eli Lilly have both made major investments in ramping up capacity, for example, Novo’s recent acquisition of Catalant. Second, with newer GLP-1 therapies already in phase three trials, we will likely see other therapies available as soon as 2026. There will always be the risk of transient shortages given concentrated supply chains and the addition of any new large patient population to the treatment pool, but we believe manufacturers and wholesalers have worked through most of these challenges.
Saurabh: How likely is the GLP-1 therapy going to impact the MedTech industry with an established potential in Cardiovascular procedures?
Saif & Andrew: We firmly believe that GLP-1s are a once-in-a-generation class that will materially change the management of obesity, diabetes, and cardiovascular disease. The reality is that each of these conditions contributes to the majority of conditions for which we undertake cardiovascular procedures, whether that’s revascularization, valvular disease, aortic or carotid disease, and other peripheral manifestations. If you lower the incidence and severity of these conditions, then the need for procedures to treat their complications will of course drop. The question is, “How much?” We are confident in our 20% estimate because our research shows that it’s not just how many people are treated, but who (from a risk standpoint) is treated that will drive down the need for these procedures in the future. A lower use of GLP-1s in the population that is focused on high-risk individuals can be just as—or more–impactful as broader adoption in an average risk group. And we need only look at how CV surgery volumes have dropped in the last two decades to see how changes in medical therapy and practice can change the need for cardiovascular procedures.
Saurabh: Like SGLT2i, GLP-1 therapies are being assessed and prescribed in both diabetic and CVD patients. Can you tell us the principal difference between both mechanisms and maybe how GLP-1 is better than SGLT2s?
Saif & Andrew: SGLT2is and GLP1s work through different mechanisms. The SGLT2is target a receptor in the kidney and promote urinary elimination of glucose, lowering blood glucose. By contrast, GLP1s work by mimicking the action of the GLP-1 hormone, which stimulates the release of insulin, slows the emptying of the stomach, and suppresses appetite. While the SGLT2 receptor is located in the kidney alone, we know that GLP1 receptors are located throughout the body – heart, brain, GI tract, vascular tissue – suggesting there are likely other ways in which we may see benefit. The choice of any agent is a personal decision between a patient and their physician. Given their different mechanisms of action, there are patients for whom either or both therapies may be a suitable choice.
About the Author:
Saif Rathore, MD PhD, Founder of Sandbar Life Sciences and Entrepreneur-in-Residence at Yale Ventures
Saif Rathore is a physician scientist with 25 years of experience in health care and life sciences, ranging from early discovery through commercialization. Saif has previously held positions with McKinsey & Company, the Boston Consulting Group, Cigna / Express Scripts, Flagship Pioneering, and the Yale School of Medicine.
Andrew Epstein
PhD MPP, Principal at Medicus Economics
Andrew Epstein is a health economist with 30 years across academia and consulting, focused primarily in health services research. A PhD graduate of the Wharton School, Andrew has held faculty positions at the Yale University School of Public Health and University of Pennsylvania School of Medicine prior to joining Medicus.
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