Dr. Javier Escalada: "In the next decade, GLP-1 receptor agonists could be used to treat more than five diseases."

"Within 10 years,it will be possible to treat more than five diseases with GLP-1 receptor agonist drugs,"said Dr. Javier Escalada, director department Endocrinology and Nutrition at the Clínica Universidad de Navarra president of the Spanish Society of Endocrinology and Nutrition Foundation, in a lecture organized by the Royal National Academy of Medicine and the Gregorio Marañón Foundation.

According to Dr. Escalada, the use of arGLP-1 drugs—which mimic the action of GLP-1—is backed by solid results in treatments for diabetes, obesity, cardiovascular disease, heart failure, and chronic kidney disease.  "There is data leads us to believe that they will also play an important role in the treatment of metabolic liver disease—fatty liver—polycystic ovary syndrome and infertility problems linked to obesity, as well as certain neurodegenerative diseases and addictions," he explained.

As Dr. Escalada previously indicated in an interview, "many of the new drugs for obesity, GLP-1 hormone agonists and others, have emerged after research has demonstrated the gut-brain connection." The specialist highlighted that clinical trials are currently evaluating the response of analogues of these receptors in different types of cancer, many of which are related to obesity—hyperinsulinism and insulin resistance—or inflammation, such as liver, breast, endometrial, or prostate cancer. In his discussion paper, Dr. Escalada revealed that "addressing metabolic disorders may become a new preventive oncology strategy."

Thus, arGLP-1s respond to pathologies that do not necessarily share characteristics with each other. GLP-1 is a peptide hormone produced in the intestine after food intake that controls sugar and appetite, and drugs that mimic the action of this hormone are currently used to treat patients with subject diabetes who have a body mass index greater than 30 and are unable to control their blood sugar in other ways. arGLP-1s are only funded for this subtype of patients. They are also indicated for the treatment of obesity and overweight accompanied by metabolic comorbidities.

The scope of arGLP-1 drugs in the body and in figures

In Dr. Escalada's opinion, the glycemic control and weight loss produced by these agonists are important advances, but they do not explain all their benefits: "There are probably direct mechanisms result the interaction of these molecules with their corresponding receptors, present in the endothelium, brain areas, etc., and also indirect mechanisms, among which the modulation of inflammation stands out."

Of a total of 3.5 million people diagnosed with subject diabetes in Spain, around 10% are being treated with an arGLP-1. According to the specialist's estimates, "between 350,000 and 450,000 overweight/obese people also receive them in Spain. I estimate that around 700,000 or 800,000 people are being treated with these drugs in our country."

However,many people with these diagnoses are still unable to benefit from these drugs or abandon treatment before reaching one year."The economic reason is clearly the most common when the indication has been obesity, because they are not funded for this purpose," he said. Hence his commitment and that of other healthcare professionals to the need to fund these drugs for certain patients. Dr. Javier Escalada clarified that "we would have to decide how to prioritize, whether based on cardiovascular risk or other comorbidities." Diabetes, which does have funding for treatment with these drugs under certain circumstances, considers other causes for patient deprivation or withdrawal treatment. These include "unrealistic expectations, gastrointestinal side effects, or insufficient follow-up by the therapeutic team," according to Escalada.

In conclusion, the director department emphasized theimportance of adequate Education to prevent or manage gastrointestinal side effects. He suggested closer monitoring and individualized progressive dose increases, clearly explaining what these drugs can offer, and, in some cases, seeking alternative routes of administration, such as oral forms, which are already beginning to appear on the scene.