Episode 238: CagriSema: The Next Generation of Obesity Treatment

[00:00:00] Welcome back to the Back on Track Achieving Healthy Weight Loss, where I help you get on track and stay on track with your weight loss journey. I'm your host, Dr. Alicia Shelly. So let's get started.

[00:00:27] Hello, everyone, and welcome back to the Back on Track Achieving Healthy Weight Loss podcast. I'm your host, Dr. Alicia Shelly. I just want to pause for a moment and share something from clinic this week. So I was talking to a patient who was doing well on ZepBound. She was losing weight, but she was on the 12.5 dose and she was nervous. She told me, she's like, Dr. Shelly, I am so scared about going up to the highest dose. And I asked her, why are you scared?

[00:00:57] She said, I'm afraid that if I get to the highest dose, I'll plateau and then I won't have anywhere else to go. And honestly, this is a really big fear that a lot of my patients have. And so sometimes I have to talk them through why it's important you get to the next dose because everybody wants to know what happens when the medication stops working.

[00:01:22] But here is the encouraging part. We have new medications that are coming out, such as Reddit True Tide. You can see a prior podcast where I talk about that. And a new medication called Cagre Sema on the horizon, meaning within the end of this year or early next year, these two medications will be out. And these medications will definitely be game changers because they have a higher weight loss than the medications that we see today.

[00:01:52] And that means we will have more options for you. So if somebody plateaues, it doesn't mean that they failed. It just means that they need to adjust the plan. The one thing I want you to remember is that when you plateau, it's to be expected because when you start to lose weight, your body works against you. It does something that we like to describe as defending the body fat.

[00:02:18] Because remember, our body is still in that survivor mode or that hunters and gatherers mode where those people who had more body fat survive. So as you start to lose weight and lose that body fat, your body works against you to preserve that body fat. And how does it work against you? It increases your hunger hormone, your ghrelin hormone, and also it slows down your metabolism. So it takes longer for you to burn the same amount of calories.

[00:02:46] So a lot of times, especially if you're doing changing your diet, you may notice that, oh, gosh, when I first started, I'm losing weight. But then it starts to slow off and you may notice that, oh, man, my cravings are back. And it's not that you don't have willpower. It's just the fact the body is working against you and it's increasing your hunger hormone so that you can bring that body fat back. And so when you do get in a plateau, there are many things you can do. Number one, maybe change the medications.

[00:03:16] Number two, use a combination therapy. And then number three, adding another tool. So today we're going to talk all about a medication that could be another tool. This medication will be released in the not so distant future, specifically either late 2026 or early 2027. And its name is Cagrissema. You may already know medications like Wegovy or Zepbound.

[00:03:43] I mean, if you watch TV, these commercials are literally everywhere. But Cagrissema is a little bit different and it may be the next step in weight loss treatment. So for those people who need more weight to be lost or people who have kind of plateaued on the Wigoli or Zepbound, this may be another option. So in this episode, I'm going to break it all the way down in a simple way. Talk about what it is, how it works and what the studies show. And what could that mean for you?

[00:04:13] So let's get into it. But first, what is Cagrissema? So Cagrysima is actually two medications combined into one. You have semaglutide and you have coagulatide. A semaglutide is the same medication that's in Wigoli and coagulatide is newer. It works like a hormone in your body called amylin, which helps control your hunger after you eat.

[00:04:39] So instead of one medication helping with appetite, you now have two working together. So let me explain this a little bit in a different way. Semaglutide helps you to feel full longer, helps you to feel less hungry and slows down how fast the food leaves your stomach. Whereas coagulatide helps you to feel full faster as well, but you eat less during your meals.

[00:05:06] So together you get full faster and you stay full longer. So it's like having two coaches instead of one helping you manage your hunger. Let's talk about the research because this is the exciting part. There are a group of studies called the redefined trials. So we're going to just talk about three of those trials. So the first trial or study was the redefined one, which looked at people without diabetes and who had obesity,

[00:05:36] plus who were overweight with a weight-related comorbidity. And the majority of people in this particular study lost up to 22.7% of their body weight over about 68 weeks. And half of them moved from obesity to overweight. Now, so far the studies that have been out for Wigobi and Zepan show that they can get up to 20.9% in the Zepan 15 milligrams.

[00:06:05] And then the Wigobi 7.2 milligrams, which is the newer Wigobi, I just talked about that last week, that was around 20% as well. So now with Cagrissema, we're going over that 20%, which is amazing. And then now we have the redefined two, which looked at people with type 2 diabetes. And in this population, also type 2 diabetes plus obesity plus or overweight with weight-related comorbidities, such as type 2 diabetes.

[00:06:35] And in this study, the majority of people who were on Cagrissema lost about 15.7% of their body weight compared to about 3% in the placebo group. Now, the one thing you have to know about is that in individuals who are living with diabetes, it is harder for them to lose weight. And the reason that is, is because of insulin resistance. In insulin resistance, you tend to have higher levels of insulin. The body is not responding to the insulin that's being reduced, so it's just kind of pulling up in the blood.

[00:07:04] And higher levels of insulin can cause your body to store body fat instead of to burn it. So in individuals living with diabetes, they tend to have higher levels of insulin just in general, and it tends to be harder for them to lose weight, which is why there is such a difference between those without diabetes and those with diabetes. But the important thing to look at here is that even if you do have diabetes, you can still lose weight.

[00:07:29] And 15.7% of your body weight is great because Wagovi 2.4 milligrams, the average weight loss was average of 15%. So you can really see a change there. Now, let's talk about the Redefine 4 trial. Now, this one was actually pretty interesting because it compared Cagrissema to Terzepatide. Now, Terzepatide is the scientific name for Zefone and Monjaro.

[00:07:56] And Cagrissema led to about 20% to 23% of weight loss, whereas Terzepatide led to about 23.6% of weight loss. So Cagrissema worked very well, but it did not beat Terzepatide. So it was what we describe as non-inferior in that study, but still pretty impressive. You know, 20% to 23% is nothing to scoff at, as well as with Terzepatide, which is 23.6%.

[00:08:23] Now, let's talk about side effects because that's the one thing everybody wants to know. Now, overall, Cagrissema is well tolerated, but it does have common side effects, including nausea, vomiting, constipation, and of course, feeling very, very full. These are mostly stomach-related trials and studies and side effects. And the one thing I will say is that everyone's different. So not everyone's going to get all of these side effects, and some people will get them and some people won't.

[00:08:52] So it just depends on your body. And I always tell my patients, I don't know how your body is going to react when we start this medication, but if we start at a low dose and taper up slowly, it can help us to reduce some of these side effects. And just remember that Cagrissema is not out yet. You can't get it yet, but hopefully toward the end of the year and early next year, it'll be ready for you to pick up at the pharmacy. Now, let's think about the people who Cagrissema can help.

[00:09:22] So it's for people like my patient who got on the highest dose of their medication and stopped losing weight, and they really need more assistance. So this medication can help you kind of boost to that next level. Also, people who still feel very hungry. I've had people who are on Zepbound and Wagovi and they just don't feel full. This medication will be helpful for them because it will help slow down. It'll help target that amylin level where they actually feel full longer, especially with eating.

[00:09:52] Also, just people who need more support with weight loss. Cagrissema can be helpful. Because remember, medication is just one part of the plan. You still need to have healthy eating, movement, sleep, and stress management. So here's the big picture. Cagrissema shows us that we are moving toward a combination treatment for obesity, just like we treat diabetes, high blood pressure. And this means we're finally treating obesity like a chronic disease

[00:10:20] because it is not about willpower. It is not about failure, but it's about biology. So let's be real for a second. With all these new medications, it definitely can feel overwhelming. And you may be thinking, should I wait for this? Am I on the wrong medication? But here's the truth. The best plan is the one that is working for you right now. So you should not wait to make progress. If the medication you're on is helping you, you're losing weight, stay on it.

[00:10:49] But if you're finding that you're plateauing and it's not making a change, then maybe it may be time to wait and possibly change once it comes out. But definitely please speak to your doctor about what is best for you. Because Cagrissema is exciting and it shows us where weight loss treatment is going. But your journey is happening right now. So if this episode helped you, share it with someone who needs it, leave a review and follow the podcast. Please subscribe.

[00:11:17] And as always, stay strong, stay committed and stay consistent. And remember, we are stronger together.