Health

Patients hate medications forever. Is Wegovy different?

Study after study shows that most people don’t take the medications they’re prescribed. It doesn’t matter what they are – Statins, Medication for high blood pressure, Medications to lower blood sugar, Asthma medications. Patients either never start taking it or they stop taking it.

It’s a problem doctors call nonadherence — the general human tendency to resist medical treatment — that leads to countless deaths and billions of dollars in avoidable medical costs every year.

But that resistance could be overcome by the blockbuster obesity drugs Wegovy and Zepbound, which have stunned the world with the way they help people lose and maintain weight. Although it is still early days and there is little data on compliance with the new medications, Doctors say they’re noticing another amazing effect: Patients seem to be taking them faithfully week after week.

Some patients may need to overcome initial reluctance. A national survey found that most people lost interest in starting the medication when they were told that they would gain weight back if they stopped taking the medication.

In a small study, patients stopped refilling prescriptions for months, possibly due to side effects, lack of availability, or insurance and cost issues.

But anecdotally, doctors and patients say those who have started taking the drugs are continuing to do so.

“I don’t plan on ever stopping taking this medicine,” said Kimberly DelRosso of Pembroke, Massachusetts, who takes Wegovy.

She never forgot to take her weekly injection. In contrast, she says, she often neglected to take her prescribed blood pressure pills when she weighed more. (Now that she’s lost weight with Wegovy, she no longer needs them.)

So far, doctors report that most of their patients, like Ms. DelRosso, intend to take the obesity medications forever, and many are thrilled when they no longer need other medications.

Dr. David Cummings, a professor of medicine at the University of Washington and director of a weight management program at the VA Puget Sound Health Care System, chronicles his patients’ experiences with Wegovy and the diabetes drug Ozempic. So far he has prescribed the medication to around 1,000 patients. At most 5 percent stopped because of side effects, he said. Others stopped because their insurance no longer covered their medication or because they couldn’t find a pharmacy that had it in stock, suggesting an ongoing drug shortage.

But those who quit typically don’t do so voluntarily, he said. Other doctors who prescribe Wegovy agreed.

“Compliance is exceptional,” said Dr. Diana Thiara, medical director of the weight management program at the University of California, San Francisco. “People take it. They ask for refills. They take it with them when they travel.”

There is a price to be paid for neglecting to take prescription medications. A staggering 40 to 50 percent of people who are prescribed medications for chronic conditions such as high blood pressure or diabetes do not take them—costing at least $100 billion in avoidable medical costs each year. It is estimated that this lack of compliance leads to at least 100,000 preventable deaths each year.

Even a heart attack may not be enough to get people to take the current arsenal of heart medications proven to prevent deaths from heart disease. Some studies are currently showing this half of people who had had a heart attack were still taking medication to protect their hearts two years later.

“These patients have seen the bright lights, ridden in ambulances, received emergency PCI, given their families secondary heart attacks, caught a glimpse of the Pearly Gates, but still seem to not take their statins and beta blockers said Amitabh Chandra, a professor of public policy and business administration at Harvard.

Even Doctors stop They take their medications, disproving the hypothesis that people do so because they don’t really understand what it means.

And even if costs play a role, at least one study found that even when medications are free, adherence can be dismal.

One reason seems to be a kind of deep-rooted reluctance to take something that reminds people every day that they are sick, or something that many patients may perceive. Especially with medications that experts call “long-term medications,” taking them daily leads to an abnormal feeling in some patients.

“People think they’re fine, so they don’t need the medication,” said Corrine Voils, a social psychologist at the University of Wisconsin who studies medication adherence. “But it’s the medicine that makes them feel good.”

Jalpa A. Doshi, a professor of medicine at the University of Pennsylvania’s Perelman School of Medicine, said patients make their own personal value judgments: “The drug has side effects, requires copays, and taking a daily pill reminds me that I am sick. But I don’t have any symptoms – I don’t see my high blood pressure or my high cholesterol.”

“And what are the benefits?” she added. “I really can’t see the benefits. “I could eat less salt and fat and walk or exercise more” instead of taking these medications.

These assessments that patients make in their heads “make quitting much easier,” said Dr. Doshi.

That describes Mark Anthony Walker, 61, of Dublin, California, whose experience with heart disease is overshadowed by a troubling family history – his father died of a massive heart attack at age 47, his mother at age 48.

When he was 26, Mr. Walker had a cholesterol level of 360.

“I was terrified,” he said.

Since then he has been on statins off and on and is now taking one. But he doesn’t plan on taking it forever. He has come to the conclusion that his brain needs cholesterol. As for taking a medication for the rest of his life, “I’m totally against it,” he said.

Instead, he believes he can control or even reverse his heart disease with a strict diet, exercise and vitamins.

Mr. Walker’s cardiologist, Dr. David J. Maron, the director of preventative cardiology at Stanford University, gently encourages him and others like him to take their medications. But as doctors know, if they charge in at gunpoint, their patients will simply go elsewhere.

So what could make the difference between obesity medications? On the one hand, although it is usually doctors who recommend medications such as statins or blood pressure medications, patients often ask doctors about anti-obesity medications. Many have spent a lifetime trying every diet and exercise program they could find, and every time they lost weight, they gained it back.

Even people who start taking the new anti-obesity drugs won’t be able to hide so easily when they stop taking them: the weight they’ve lost may come back, along with the stigma, shame and self-blame that often comes with it associated with obesity. This makes these medications very different from most others.

“You don’t wear a big sign on your chest that says ‘blood pressure medication stopped,'” says Dr. Walid Gellad, a professor of medicine at the University of Pittsburgh who studies medication adherence.

The downside, however, is that obesity medications are expensive and often require doctors to fill out tedious insurance pre-approval forms. The medicines were constantly in short supply across the country. These obstacles can make it difficult to get them.

Other disadvantages of the medication include side effects such as nausea and gastrointestinal problems as well as the method of administration – patients have to inject the medication themselves once a week.

In a study At the Cleveland Clinic, Hamlet Gasoyan and his colleagues examined the electronic health records of 402 patients at sites in Ohio and Florida who were taking Wegovy or Ozempic for obesity. They found that only 161, or 40 percent, had consistently refilled their prescriptions throughout the year. Side effects, availability, or insurance and cost issues may have played a role.

But there’s a reason patients are willing to call dozens of pharmacies every week to search for the drugs and inject them diligently: Without obesity, they feel like they look better and are perceived differently. You will no longer be shunned or shamed. People no longer stare at their shopping cart or comment when they eat a bowl of ice cream. The embarrassment and self-blame and never-ending stigma of obesity are gone.

That’s a big factor for Ms. DelRosso.

People with obesity “are treated differently,” she said, adding: “It’s just terrible how people devalue you because you’re heavy.”

But she is also happy about the health effects. She doesn’t have sleep apnea or high blood pressure, and her blood sugar, which was in the diabetic range, has dropped.

“I don’t have to take any medication anymore,” she said.

Except for Wegovy, of course.

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