Cheap obesity pills are already on the market
Weight-loss pills are all the rage, with stars including Oprah and Amy Schumer having spoken up about all the pounds they’ve shed on GLP-1 drugs like Ozempic. Without widespread insurance coverage, many patients have struggled to get affordable GLP-1 prescriptions. But there are other, older weight-loss pills already on the market that are both effective and far less expensive.
One of the most effective of those drugs is a once-daily tablet called Qsymia. People lose around 11% of their body weight on average after a year on the drug. Eli Lilly and Novo Nordisk are seeing around 15% reductions from the weight loss pills that they're currently developing.
Qsymia, which is manufactured by Vivus, launched in 2012. The drug won US approval in 2022 to be used by children as young as 12. But it has never had the same success as newer drugs like Ozempic. Demand picked up a bit recently, possibly riding the wave of GLP-1 popularity.
That could be because of the side effects that come with the drug.
“Obesity is a long-term disease,” says Sean Wharton, adjunct professor of medicine at McMaster University, who has co-authored studies of GLP-1s. “Therefore the medication should be safe long-term as the patient changes throughout life.”
Both Qsymia and GLP-1s have boxed warnings, which are the highest US safety-related alerts for medications. Qsymia can trigger an increase in heart rate and serious eye problems, among other adverse events, according to the drug’s website. It can also cause birth defects, such as cleft palate, that prohibit pregnant women from taking it. A recent study found older diet pills, including ingredients found in Qsymia, led to more suicidal ideation than Ozempic or Wegovy.
Additionally, one of Qsymia’s active ingredients, the appetite suppressant phentermine, is a controlled substance, meaning it comes with some risk of addiction. It was also one of the ingredients in the now infamous diet drug fen-phen, which was pulled from the market in the late '90s after the other half of the combination, fenfluramine, was found to cause heart valve problems.
Vivus CEO John Amos said in an email that Qsymia is as effective as some GLP-1s and isn’t associated with many side effects. “Clinical research supports that Qsymia is one of the most efficacious drugs on the market,” he said.
GLP-1s, meanwhile, are mostly known to cause gastrointestinal symptoms, especially nausea. They can also lead to swelling of the pancreas and have a warning regarding the risk of thyroid tumors.
When patients are priced out of GLP-1 drugs, though, older options like Qsymia provide a crucial second choice. They may also be a good option for patients who can’t tolerate the gastrointestinal side effects of GLP-1s, says Absalon Gutierrez, associate professor of endocrinology, diabetes and metabolism at the University of Texas Health Sciences Center at Houston.
Experts also think older drugs may play a role in combination with newer ones, helping patients maintain weight loss after stopping GLP-1s.
The pill version of weight-loss drugs from Lilly and Novo have yet to be approved, but if the list price of their injectable versions are a barometer, they will likely be far more expensive than Qsymia, which costs as much as $270 a month. Lilly’s Zepbound has a list price of $1,060 and Novo’s Wegovy is $1,349 a month.
Newer drugs may come with fewer side effects, but for now they are also accessible to far fewer people. — Nacha Cattan