Jan Friberg M.D., Ph.D.
Obesity has long been a concern and the rate has dramatically increased in recent years. Obesity increases the risk for development of medical problems such as diabetes and cardiovascular diseases. In the U.S. population, obesity is also present in up to 80 % of patient with polycystic ovarian syndrome (PCOS), characterized by hyper-androgenism, ovulary dysfunction and polycystic ovaries. Diet and exercise is emphasized in the treatment of obesity and a weight loss of 5% or more in PCOS patients have been shown to have a significant positive impact on the return of ovulatory cycles and pregnancy rates (1). Medications such as Orlistat, Phentermine, and Sibutramine have a place in the pharmacological treatment of obesity and we have now got a new glucagon – like peptide 1 receptor agonist called liraglutide (Saxenda® and Vegovy®) that works on the blood glucose levels by enhancement of the insulin secretion from the pancreas. A randomized controlled trial in 2015 also showed that liraglutide had unexpected positive effect to weigh loss. Over a year a 8% weight loss occurred in the test group whereas only 2.6% shows weight loss in the placebo group (2). In another similar but extensive study, the weight loss was 16% in the treated group and 5% in the placebo group. Combined with life style corrections, the liraglutide treatment resulted in a significant weight loss in patients who were overweight or obese.
We have now a recent publication on the effect of liraglutide on patients with PCOS (3). In an eight month study, 57% of the treated women achieved a goal of 5% or more weight loss compared to 22% in the control group. Androgenic parameters was also significantly reduced whereas it increased in the placebo group. It was concluded that liraglutide was superior to placebo to treat all types of adverse symptoms that occur with PCOS.
The dosing of liraglutide of 3 mg s.c. per day is much higher than the dose of liraglutide used in the diabetes treatment drug Victoza. Unfortunately, the price for one months treatment is in the range of $1,000. The drug has to be preapproved and many insurance companies do not approve this treatment although a significant weight loss will improve the quality of life and longevity which is what we all strive for. Is an expense of $1,000 a month worth better health? Only you yourself can answer that question. We will work with you and your insurance company to improve your quality of life and will lobby for you in the insurance jungle.
References
- American College of Obstetricians and Gynecologists. ACOG practice bulletin no 194: polycystic ovary syndrome. Obstet. Gynecol. 2018; 131:e 157-e171
- Pi-Sunyer X, Astrup A, Fujioka K, Greenway F, Halpern A, Krempf. A randomized controlled trial of 3.0 mg of lisaglotide in weight management. N. Engl. J. Med. 2015; 373: 11-27
- Elkincl-Hirsch KE, Chappell N, Shaler D, Storment J, Bellanges D. Liraglutide 3 mg on weight, body composition, hormonal and metabolic parameters in women with obesity and polycystic ovary syndrome: a randomized placebo-controlled phase 3 study. Fertil Steril. 2022; 118: 371-381