Zepbound, Mounjaro improves symptoms in clinical trial

By Staff 8 Min Read

  • Around 70% of people who have obstructive sleep apnea also have obesity.
  • A new clinical trial from drugmaker Eli Lilly shows that Zepbound and Mounjaro improved symptoms of obstructive sleep apnea.
  • Tirzepatide, the main ingredient in these medications, reduced symptom severity by nearly two-thirds.
  • Weight loss was reported in 20% of participants taking tirzepatide.

Sleep apnea occurs when a person has difficulty or stops breathing when sleeping. The most common type of sleep apnea is called obstructive sleep apnea.

Researchers estimate that about 70% of people who have obstructive sleep apnea also have obesity.

The latest numbers from the World Health Organization (WHO) report that obesity affects more than 1 billion people globally.

Recently reported results from a phase 3 clinical trial found tirzepatide — the main ingredient found in type 2 diabetes medication Mounjaro and weight loss treatment Zepbound — helps reduce symptom severity by almost two-thirds in adults with obesity and obstructive sleep apnea.

The results of this clinical trial have yet to be published in a peer-reviewed scientific journal.

Eli Lilly and Company — maker of both Mounjaro and Zepbound — recently reported results from the SURMOUNT-OSA clinical trials examining the use of tirzepatide for improving obstructive sleep apnea symptoms.

The trial included 469 study participants from the United States, Brazil, China, Australia, Germany, and four other nations.

Participants had moderate-to-severe obstructive sleep apnea and obesity and were either unable or unwilling to use positive airway pressure (PAP) therapy — examined during SURMOUNT-OSA Study 1 — or were and planned to continue to use PAP therapy during the trial, which was looked at during SURMOUNT-OSA Study 2.

For both studies, participants received either a dose of tirzepatide or a placebo for 52 weeks.

Upon analysis, researchers found that participants who received tirzepatide injections experienced a significantly reduced apnea-hypopnea index compared to those taking the placebo.

The apnea-hypopnea index is an obstructive sleep apnea diagnostic tool used to count how many times your breathing partially or fully stops when asleep.

Scientists also reported that weight loss between the two studies was about 20% in participants who took tirzepatide.

Obstructive sleep apnea is a comorbidity of obesity, meaning it is most commonly seen in people with overweight or obesity.

“Obstructive sleep apnea is a sleep-related condition that results in the blockage or collapse of the upper airway, causing the sufferer to stop breathing several times a night,” Monique May, MD, a board certified family physician for Aeroflow Sleep, not involved in the clinical trial, explained to Medical News Today.

“The obstruction can be caused by a thick tongue, a thick neck, or excess fatty tissue in the upper airway, all of which are more common in [people with obesity],” May noted.

Previous studies show that obstructive sleep apnea can impair a person’s quality of life as it negatively impacts their capability of getting a good night’s sleep.

“The thinking is (that) excess fat deposits in the airways and decreases the caliber of the airway, and it makes the tissue more floppy, so it’s easier to block the airway when sleeping because of the extra fat around the airway,” Mir Ali, MD, bariatric surgeon and medical director of MemorialCare Surgical Weight Loss Center at Orange Coast Medical Center in Fountain Valley, CA, told MNT. Ali was not involved in the clinical trial.

Additionally, research shows that obstructive sleep apnea can increase a person’s risk of:

“Low oxygen levels while sleeping causes many diseases and sudden life threatening events,” Seth Kipnis, MD, medical director of bariatric and robotic surgery at the Hackensack Meridian Jersey Shore University Medical Center in New Jersey, explained. Kipnis was not involved in the clinical trial.

“These include heart disease, heart attacks, strokes, high blood pressure, (and) daytime fatigue. Poor sleep also leads to worse eating patterns and weight gain. This vicious cycle of poor sleep and obesity makes everything worse. Significant sustainable weight loss reverses this cycle,” Kipnis told MNT.

Ali said he was not surprised by the results of Eli Lilly’s clinical trial because this is something he sees with post-weight loss surgery patients.

“It’s not directly from the medication, but a secondary effect of losing weight,” he explained. “Any form of weight loss improves obstructive sleep apnea.”

“This is expected,” Kipnis added. “Anything that treats obesity well will also improve all comorbid conditions associated with obesity, including sleep apnea.”

May noted it is extremely important that researchers continue to find ways of reducing sleep apnea severity in people with obesity and obstructive sleep apnea.

“The number of people affected with obstructive sleep apnea is already around 40 million, and unfortunately, as the rates of obesity increase, that number will continue to rise. It will be good to have a nonsurgical option to address both weight loss — versus bariatric surgery — and obstructive sleep apnea reduction vs upper airway surgery to remove excess tissue in the throat or a uvulopalatopharyngoplasty.”

— Monique May, MD, a board certified family physician

When asked about what she would like to see as the next steps for this research, May said she was surprised by the small number of participants.

“I would want to see more (information) about the selection process and why the participant pool was so small,” she continued. “With such a large population of affected people in the U.S. alone, I would think it would have been easier to secure more study participants.”

May added she would like to see data at shorter endpoints than a year, such as six weeks, 12 weeks, or four to six months, the same studies done by unbiased researchers outside of the pharmaceutical manufacturer, and the breakdown of the response of men by ethnicity.

“This would allow physicians to target treatment better for males, as this incretin may be better for males than others in the class,” she added.

Ali said it would be interesting to see the time it takes to reduce sleep apnea symptoms compared to other weight loss methods.

We see the resolution of sleep apnea and other conditions fairly quickly after surgical weight loss and the weight loss with these medications (is) a little bit slower,” Ali noted. “So for me, it’d be interesting to see what the time of resolution of these symptoms is.”

Kipnis said that research needs to prove to Medicare and insurance companies that obesity treatments should always be covered.

“By not covering or restricting access to effective weight reduction strategies, we have a population that is suffering. Currently, Medicare does not cover these drugs. Overall healthcare spending on an individual would drastically drop if obesity was prevented or treated.”

— Seth Kipnis, MD, bariatric surgeon

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