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Indian Express
6 days ago
- Health
- Indian Express
Eli Lilly's new oral weight loss pill works as well as injectables: Why this could be better than oral semaglutide?
The blockbuster weight loss drug, semaglutide, now has competition in orforglipron, which is just as safe as injectable alternatives and more effectively lowers HbA1c (average blood sugar count of three months) in patients with type 2 diabetes and obesity. The best part. No injections required — just a daily pill. The investigational once-daily pill by US manufacturer Eli Lilly lowered HbA1C by an average of 1.3% to 1.6% across doses, with improvements seen as early as four weeks, in adults with type 2 diabetes, according to Phase 3 results of the ACHIEVE-1 trials, published in The New England Journal of Medicine. Orforglipron also led to an average weight loss of 16.0 lbs or 7.3 kg (7.9%) at the highest dose by week 40. 'The efficacy, safety, and tolerability are really consistent with the very best injectable GLP-1s,' Kenneth Custer, president of cardiometabolic health at Eli Lilly, was quoted as saying. Why is orforglipron effective? Orforglipron and semaglutide are both GLP-1 receptor agonists, which mimic the effects of the naturally occurring hormone GLP-1, which helps regulate blood sugar, reduce appetite and slow down gastric emptying. But while orforglipron is non-peptide, semaglutide is a peptide. Peptides are smaller than proteins, while non-peptides encompass a wider range of chemical compounds with diverse structures and functions. 'Orforglipron, being a non-peptide, is a smaller molecule. This allows better absorption of the drug through the gut. They don't get broken down as easily by digestive enzymes. Hence the efficacy,' says Dr Anoop Misra, chairman, diabetes and endocrinology, Fortis C-Doc. What are the advantages of orforglipron over semaglutide? Orforglipron is an oral pill taken once daily, while semaglutide is available as both an oral tablet (Rybelsus) and a subcutaneous injection (Ozempic, Wegovy). 'Previous oral GLP-1s like semaglutide (Rybelsus) are peptide-based and have significant limitations — they must be taken on an empty stomach with minimal water and have much lower bioavailability than injectable form. Orforglipron is a small molecule that doesn't require food or water restrictions, so it is very convenient and is absorbed easily,' says Dr Misra. What about the trial results? At 40 weeks, all three doses (3 mg, 12 mg, 36 mg) of orforglipron achieved the primary goal of superior HbA1C reduction. Improvements in HbA1C were observed as early as four weeks and were accompanied by similar reductions in fasting serum glucose. 'The early onset of glycemic improvement, observed as soon as four weeks, reinforces the therapeutic potential of orforglipron as an effective, oral GLP-1 therapy for early type 2 diabetes treatment. These findings support further investigation in broader populations and longer-duration studies,' said Dr Julio Rosenstock, senior scientific advisor for Velocity Clinical Research at Medical City Dallas, clinical professor of medicine, University of Texas Southwestern Medical Center, and lead trial investigator. What about side effects? In the study, orforglipron had a safety profile similar to the established GLP-1 class of medication. The most frequently reported adverse events were gastrointestinal-related.
Indian Express
10-06-2025
- Health
- Indian Express
Should Type 5 diabetes be a category at all? Top diabetologists question lack of evidence, data
Top endocrinologists have questioned the way Malnutrition-Related Diabetes Mellitus (MRDM) has been hastily rechristened as Type 5 diabetes by the International Diabetes Federation (IDF). In an expert review, Dr Anoop Misra (chairman, Fortis C-DOC Hospital for Diabetes and Allied Sciences), Dr Ambrish Mithal (chairman, Endocrinology and Diabetes at Max Healthcare) and Dr Shashank Joshi (diabetologist, Lilavati Hospital, Mumbai) have argued that the new classification runs ahead without robust modern evidence or clearly defined diagnostic criteria. Their critical analysis was published in Diabetes & Metabolic Syndrome: Clinical Research & Reviews recently. 'Reclassifying MRDM as Type 5 diabetes is premature and not supported by current evidence,' they wrote. They argue that MRDM, though first recognised in 1985, was declassified in 1999 due to poor evidence. They say the same holds true today as overlapping symptoms continue to be misleading, the body mass index (BMI) criteria are considered outdated and there is not enough data to warrant a separate type of diabetes. 'We still need rigorous research and definitive biomarkers for such a classification. Besides, there has to be a global consensus,' says Dr Misra. Excerpts: Why can't MRDM be classified as Type 5 diabetes? There's no conclusive evidence that MRDM is a distinct disease rather than a variant or complication of existing diabetes types. Only a distinct phenotype (traits which define the 'what' of a disease) with robust data different from established types merits new classification. MRDM overlaps with other types of diabetes — type 1 (due to autoimmune markers in some cases), type 2 (with insulin resistance or secretory defects), and secondary diabetes (when the pancreas doesn't produce enough digestive enzymes). There's inadequate evidence. Only a few, small-scale studies, such as the 2022 study by Lontchi-Yimagou, exist. Rest are 25-40 year old data, some of which is mostly clinical. These studies are largely cross-sectional and limited in scope, sample size and generalizability. The American Diabetes Association (ADA) and WHO have never formally acknowledged type 3 or type 4 diabetes, making the proposal of a 'type 5' both arbitrary, confusing and unacceptable. What's needed for a classification? A valid classification demands a clearly distinct cause or causes, well-defined diagnostic criteria, international consensus and therapeutic utility. MRDM does not currently satisfy these requirements. Did MRDM ever receive the attention it deserved? The WHO classified it as a separate category in 1985 and it was discussed in international diabetes forums such as the 1976 IDF Congress. However, this attention waned due to the poor quality and limited quantity of research, which was largely descriptive and observational. Eventually, the WHO removed MRDM from its classification in 1999, citing insufficient evidence. In India, MRDM has become increasingly rare. Many experts report not encountering it at all, suggesting its relevance has significantly declined. Should MRDM be treated as a type or a subset of diabetes? MRDM is best viewed not as a separate type of diabetes but as a subset or modified form of existing types, most likely falling under secondary diabetes or as a variant of type 1 or type 2 diabetes. This type is influenced by factors such as chronic undernutrition. Defining it as a distinct 'type' risks oversimplification and could introduce unnecessary confusion in diagnosis and management. What is the classification's impact in India? India historically played a major role in defining and reporting MRDM, contributing to a significant volume of early literature. But MRDM was also reported from many other tropical countries. However, current data reveal a steep decline in the prevalence of undernutrition (proxy by BMI). For instance, thinness among women aged 20–54 dropped from 31.7% in 1999 to 14.2% in 2021. Moreover, many individuals with low BMI in India are constitutionally thin and not necessarily malnourished or unhealthy. Reintroducing MRDM as a major category today risks diverting clinical attention and public health resources away from the pressing and widespread problem of type 2 diabetes, which remains the dominant and surging diabetes burden in India. What more evidence is needed? We need large-scale, prospective cohort studies with long-term follow-up; detailed nutritional, immunological and metabolic profiling; insulin secretion and sensitivity assessments using gold-standard methods; standardized malnutrition definitions; and comprehensive genetic research. Without this evidence base, the proposal to reclassify MRDM is premature, unsubstantiated and unacceptable. How does Type 5 classification hamper treatment protocol? Classifying MRDM as 'Type 5 diabetes' may introduce more confusion than clarity. It suggests a degree of diagnostic and therapeutic precision that does not exist. Moreover, such a label does not provide actionable clinical guidance, as patients show variable insulin needs and mixed autoimmune markers. It could also mislead policymakers and healthcare providers, diverting attention and funding from more prevalent and well-characterized diabetes forms such as type 2.
News18
07-06-2025
- Health
- News18
81,000 Vials, Rs 24 Crore In 3 Months: Weight Loss Drug Mounjaro Sales Triple As Patients Shift To Higher Dose
With three months since its launch in India, according to latest Pharmatrac data, Mounjaro clocked Rs 12.6 crore in sales in May 2025—a threefold increase from March In a sign of rising adoption, sales of Mounjaro—the breakthrough weight loss and type 2 diabetes drug—have nearly tripled in the last two months, data shows. American drugmaker Eli Lilly launched Mounjaro in India on March 20, triggering immediate frenzy, especially among those looking to achieve weight loss and glucose control. Doctors told News18 they were flooded with requests from patients eager to start Mounjaro or learn more about its benefits. With three months since its launch in India, according to latest Pharmatrac data, Mounjaro clocked Rs 12.6 crore in sales in May 2025—a threefold increase from March. The higher dosage form of five milligram, in particular, more than doubled in value and quantity sales between April and May, indicating a strong trend of patient progression to the next stage of treatment. As per the medical protocol, patients start with lower dosage of 2.5 milligram weekly dose and upgrade to 5 milligram after four weeks. 'This clinical shift is clearly reflected in market numbers. Five mg pack sales jumped from Rs 3.08 crore in April to Rs 7.53 crore in May, while unit sales rose from over 9,300 to over 22,900," Sheetal Sapale, vice-president (commercial), Pharmatrac, told News18. 'Looking at these trends and the acceptance of this therapy—by physicians as well as patients—along with the affordable pricing of Rs 18,000 to Rs 22,000 per month dosage indicates a definite pick up in consumption." The total market for Mounjaro has reached Rs 23.94 crore over the past three months, selling more than 81,000 vials of the drug—signalling growing adoption in diabetes care protocols. According to Dr Anoop Misra, chairman, Fortis C-DOC Centre of Excellence for Diabetes, Metabolic Diseases and Endocrinology, clinical use of Mounjaro in India closely reflects the trends observed in the data. 'A substantial number of patients are being initiated at 2.5 mg, with a timely escalation to 5 mg in line with recommended protocols. This pattern suggests good tolerability and early clinical efficacy in glycemic control and weight reduction." Misra told News18: 'With growing familiarity and broader access, increased use of higher doses (7.5 mg and above) is likely, especially in patients requiring enhanced metabolic outcomes." The injectable drug is approved by India's apex drug regulatory body, Central Drugs Standard Control Organisation (CDSCO). Mounjaro is a once-weekly injection priced at Rs 4,375 for a 5 mg vial and Rs 3,500 for a 2.5 mg vial, making the monthly expenditure around Rs 14,000-Rs 17,500. The drug is claimed to be 80 per cent cheaper than in the United States. Entry-Level Dosage Sales Plateau Mounjaro, the brand name for Tirzepatide, a once-weekly injectable, is a first-in-class medication that combines the effects of two naturally occurring hormones: GIP (Gastric Inhibitory Polypeptide) and GLP-1 (Glucagon-Like Peptide-1). Data shows that the 2.5mg dose of Mounjaro—generally prescribed as the starting regimen for type 2 diabetes patients or those looking to shed weight—has shown signs of 'plateauing growth". This trend confirms a gradual shift to higher doses. The sales value for the 2.5 mg injection rose marginally from Rs 4.80 crore in April to Rs 5.08 crore in May, after a steeper increase from Rs 1.42 crore in March. The data shows that the unit sales also reflect this trend, increasing from 5,400 in March to 18,270 in April, but only marginally to 19,350 in May. While the 2.5 mg variant remains essential for entry-level patient initiation, its month-on-month growth may continue to taper off as the patient base matures and advances to the next phase of dosing.
The Hindu
24-05-2025
- Health
- The Hindu
Reshaping India's waistline
If endocrinologist Dr. Anoop Misra's exhausted smile and constantly buzzing phone are any indication, the newest hormone-mimicking drug-based entrant into the Indian weight-loss market — tirzepatide, sold under the brand name Mounjaro, manufactured by American pharmaceutical company Eli Lilly — is the hottest selling product in the wellness and enhanced longevity market today. 'People have been waiting for it to enter India and the hype around these drugs is only growing,'' says Dr. Misra, who heads Fortis C-DOC Hospital for Diabetes and Allied Sciences in Delhi. He says his facility has been getting 10-12 enquiries for the drug every day since March, when the domestic market was allowed to retail it. 'Dieting, exercise and other interventions aside, these drugs are a game changer in the weight-loss industry,'' he explains, adding that these are prescription drugs and must be combined with diet and exercise for efficacy. Tirzepatide received approval from American authorities in 2022 to regulate type 2 diabetes and in 2023 for obesity management. After approval in India by the Central Drugs Standard Control Organisation, this weekly injectable, single-molecule drug, priced at ₹3,500 for a 2.5 mg vial and ₹4,375 for a 5 mg vial is being prescribed and taken despite its price. The most common side effects of Mounjaro include nausea, diarrhoea, decreased appetite, vomiting, constipation, indigestion, and stomach pain, but people are willing to live with those. The drug, and others like it, were developed in a world tilting towards excessive weight. The World Health Organization (WHO) says that in 2022, one in eight persons lived with obesity, with adult obesity more than doubling since 1990. Considered a chronic multisystem disease, anyone who has a body mass index of 30 or over is said to be obese (the formula — weight in kg divided by height in metre square — determines if a person is obese). Obesity affects a person's quality of life and is associated with a shortened life expectancy. WHO has termed it 'an epidemic'. A person with the disease is prone to over 10 kinds of cancers and a host of other diseases including type 2 diabetes, hypertension, fatty liver, cardiovascular diseases, osteoarthritis and mental disorders, among others. Life lessons Aruna Lal (name changed to protect privacy), who will be 60 years old this year, says she has tried many weight-loss interventions. 'I realised that no matter what I do, I can only lose weight on a consistent calorie deficit, and these drugs help me do just that. I tried diets, exercising, walks and calorie counting,'' she explains while speaking about her now decade-long battle with weight gain. She admits that each time, she fell off the wagon. Aruna, at 5 feet 2 inches, says that she went from 52 kg to the 84 kg she is currently at, over a span of a few decades. 'I blame my weight gain on overeating,'' she says squarely, laughing. With three children, a career as an art collector and seller, and maintaining three homes across Goa, Mumbai, and Singapore, Aruna had many stressors, including moving countries to be with her husband who worked in a multinational company. 'During this period, the weight crept up on me and last year I had a cancer scare (of the uterus). It made me sit up and relook at my health,'' she says. Last year in Singapore, Aruna decided to use the new class of anti-obesity drugs called glucagon-like peptide 1 (GLP 1), which promised sure-shot weight loss. Her doctor put her on Ozempic, which contains the active ingredient semaglutide and is available in India only on the grey market. Ozempic is also a prescription drug, given as an injection under the skin. It is recommended for type 2 diabetes and is now extensively used to manage weight. 'The first dose killed me,'' says Aruna. 'This was even though my son had already been using the drug and had briefed me about the possible side effects.' Ozempic is available in pre-filled pens with specific strengths: 0.25 mg, 0.5 mg, 1 mg and 2 mg. Her doctor put her on 1 mg because lower doses were not available at the time. 'The result was nausea, diarrhoea and a general feeling of being overwhelmed. I also experienced muscle loss and associated skin sagging. But the drug helped me cut my weight by 5 kg in a few months,'' she says. The symptoms began to impact her lifestyle, so she gave it up. She has now put back some of the weight but is determined to begin again. Doctors and patience Weight loss through semaglutide and tirzepatide use is done after extensive individual consultation. Doctors often start patients on the lowest dose and then build it up. 'Hormonal drugs must be prescribed under the supervision of an endocrinologist, often in consultation with a physician. These medications have specific effects on the body and require careful monitoring,'' says Dr. Pankaj Kumar Hans, the associate director and a unit head at the Minimal Invasive Metabolic, Bariatric and Robotic Surgery, Asian Hospital, in Delhi. He also says that like bariatric surgery, not all with obesity qualify for drug-based weight loss. For instance, those with a family history of thyroid cancer are asked not to take the drugs. Aruna's son started taking Ozempic at 31 and has been on it for a couple of years now. 'I first became conscious of my weight when I was 18 and at 100 kg; later this went up to 107. When I went in for a medical consultation, it was for my sleep apnoea. The doctor suggested Ozempic for weight loss and after I started taking it my weight came down to 90 kg in three months,' he says. He started at the lowest dose. 'What the drug has done is to ensure that I have no cravings for the wrong type of food. It is like having a coach alongside you all the time who slaps you when you try to put something unhealthy into the food. This habit stays,'' he explains, adding that he has also begun to exercise. He too says that higher doses did not go well for him. How the drugs work Weight-loss medications include both oral and injectable options. 'Currently in India, both tirzepatide and semaglutide are marketed under the brand names Rybelsus and Wegovy (both semaglutide), and Mounjaro or Zepbound (both tirzepatide),'' explains Dr. Misra. Explaining the difference between semaglutide and tirzepatide, he says, 'Semaglutide and tirzepatide differ in their mechanisms of action. Semaglutide is a glucagon-like peptide-1 (GLP-1) receptor agonist, meaning it stimulates GLP-1 receptors; tirzepatide is a dual agonist, acting on both GLP-1 and glucose-dependent insulinotropic polypeptide (GIP) receptors. This dual action of tirzepatide may lead to more significant weight loss and glycaemic control compared to semaglutide.' Simply put, both the drugs result in increased satiety, forcing users to eat less. At the time of the launch of the drug in India, Eli Lilly and Company said it is 'an innovative option to treat obesity and type 2 diabetes'. The company's statement also added that the drug plays a vital role in supporting individuals living with obesity — not only in managing the condition but also in preventing related complications. However, it also warned against self-diagnosis and administration. 'People with obesity should consult their treating physician to determine whether this treatment is appropriate for their individual medical needs,' it said. There are other, older medicines that have claimed they assist in weight management: Lirafit (liraglutide); Xenical (prescription) Alli (over the counter), both orlistat, a lipase inhibitor, manufactured by GlaxoSmithKline. Other generic orlistat products are Obelit (Intas Pharma), Zerocal (Weidar), and Cobese (Ranbaxy). 'The Indian weight-management market was valued at $25.2 billion in 2024,' says a report by IMARC, a global management consulting firm which does market assessment and feasibility studies. It predicts that the Indian weight-management market will see a compound annual growth rate of 8.79% between 2025 and 2033. Speaking about it openly Saroj Singh, 45, lives in central Delhi, and has recently started Mounjaro. She says that both her older sisters in America benefitted from Ozempic and lost almost 10 kg each. 'Obesity, hypertension, diabetes — you name it, we three sisters have it. All three of us started putting on weight after childbirth and related complications. I was waiting for Mounjaro to come into India because importing Ozempic was expensive,'' she says. Saroj underwent a body-mind evaluation and counselling session by the hospital she consulted before starting on the weight-loss drug. 'I was made aware of how my eating habits need to change and how I need to manage my side effects and pack in some physical activity to boost my overall well-being and weight loss,' she says. 'I started on the lowest dose this April and have already lost 3 kg. This was something I struggled to achieve earlier. I am experiencing the known symptoms but slowly my body has fallen into a rhythm,'' she says, adding that unlike before, there is no shame in saying that you are taking the help of drugs to maintain or lose weight. 'There was so much guilt associated with this earlier. However, people are realising that obesity is a disease like any other illness and it needs to be treated,'' she says. Some part of the openness is also because it has legal ramifications. 'Under the Indian law, a higher health insurance premium on account of obesity is permissible,' says Sonam Chandwani, managing partner, KS Legal & Associates, a law firm in Delhi. 'Under the Insurance Regulatory and Development Authority of India guidelines, the insurer may consider obesity as a risk factor, justifying premium variation,'' she explains. India already offers surgical interventions to combat certain types of obesity, including bariatric surgery, gastric bypass and fat removal surgery. Some of these, including bariatric surgery, are now being covered under insurance. An obesogenic environment The weight-loss industry began booming in India in the 1990s, around the time of liberalisation and the opening of the economy to international brands, including packaged and fast foods. According to the Global Obesity Observatory, an online platform and database hosted by the World Obesity Federation, obesity cost India approximately $28.95 billion (₹2.4 lakh crore) in 2019, accounting for 1.02% of the GDP then. This burden is expected to surge to $81.53 billion (₹6.7 lakh crore) by 2030, reaching 1.57% of the GDP. The Indian health budget, as a percentage of GDP, is around 1.9%. As per the government's National Family Health Survey 2019–21 overall, 40% of women and 12% of men are abdominally obese in the country, a major risk factor for various lifestyle diseases, including type-2 diabetes. In India, the high prevalence of abdominal fat was found in the southern States of Kerala (65.4%) and Tamil Nadu (57.9%) and the northern states of Punjab (62.5%) and Delhi (59%). There is low prevalence in the States of Jharkhand (23.9%) and Madhya Pradesh (24.9%), reveals the study 'Abdominal obesity in India: analysis of the National Family Health Survey-5 (2019–2021) data', published in The Lancet Regional Health — Southeast Asia. Obesity is the result of several factors, including stress and lifestyle habits, like the lack of movement and not enough rest. A big part of the problem is that urban environments are not built for health. Arun Gupta, who founded the Breastfeeding Promotion Network of India and has been advocating for healthy foods for over a decade, says that rapid urbanisation, economic development, increased access to processed foods, globalisation, and changing social norms are all contributing factors to obesity. Vanita Rahman, an internal medicine physician, certified nutritionist and weight-loss specialist with the Physicians Committee for Responsible Medicine in America, notes that a nutrient-rich, fibre- and protein-packed plant-based diet is still an effective and sustainable weight-management technique. bindu.p@ Edited by Sunalini Mathew.
The Hindu
17-05-2025
- Health
- The Hindu
Ozempic will not solve India's obesity problem The Hindu Huddle 2025
In a compelling discussion titled 'The Trojan Horse of Indian Healthcare', panellists Dr. Anoop Misra, Dr. Preetha Reddy, and Dr. Chandrakant Lahariya tackle the growing burden of non-communicable diseases (NCDs) like diabetes, obesity, and mental health challenges in India. Dr. Misra warns against the hype surrounding weight-loss drugs and health fads like ketogenic and gluten-free diets. Instead, he advocates for low-cost, sustainable dietary changes. Dr. Reddy flags the demographic risks of rising obesity among youth. At the same time, Dr. Lahariya highlights the hidden epidemic of mental illness and the need for policy reforms on sugar and salt consumption. The panel calls for urgent public health interventions to prevent India's demographic dividend from becoming a healthcare liability.
