Mounjaro treats liver disease. Another win for the blockbuster class of weight loss drugs that includes Ozempic and Wegovy.

Your "Five on Friday" lead story for June 14, 2024...

We are back with “Five on Friday", the feature where Inside Medicine behaves like an actual medical/health/science newsletter. Also, please vote in the poll at the end!

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Here we go…

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Item 1: Mounjaro (similar to Ozempic and Wegovy) treats liver disease.

Reducing the number of patients who need liver transplants would be a good thing. Well, in yet another win for “GLP-1ra” drugs—blockbuster compounds like Ozempic and Wegovy—researchers published encouraging new data this week in the New England Journal of Medicine that points towards that possibility. In a randomized controlled trial, either placebo or Mounjaro (Tirzepatide)—a drug that works similar to Ozempic and Wegovy—was given to patients with MASH (metabolic dysfunction–associated steatohepatitis; MASH used to be called non-alcoholic steatohepatitis, or NASH). The patients who received Mounjaro showed vast improvement on biopsy a year after treatment was initiated, compared to placebo recipients. Clinical outcomes (including rates of liver transplant) were not measured because more time would be needed to see such results. Nevertheless, the improvement on a variety of markers of moderate or severe liver disease was dramatic. Now, generally speaking, studies that rely on proxy measures of health such as lab tests and biopsy results can be a little too rosy compared to patient-centered results (like being alive and feeling well). But given the amazing clinical benefits these drugs have conferred in a variety of other medical conditions, there’s reason to be optimistic that downstream complications and even mortality may improve due to these drugs. As I said last year, there is no class of drugs that I’m watching with more interest than anticipation than “GLP-1ra’s.”

Item 2: Covid-19 vaccine side effects predict antibody levels

Every time I’ve received a dose of a Covid-19 vaccine, it has been followed by a day or two of complete misery (albeit, quite responsive to ibuprofen or Tylenol). To cheer myself up during those unpleasant times, I’ve always told myself (without direct evidence) that perhaps my especially strong reaction to the doses meant that my immune system would remember what it just saw, and leave me with excellent immunity against Covid-19. It was a sensible idea, but not one I could back with data. Now there is data showing that it’s probably true! A new study published in the Annals of Internal Medicine found a correlation between the severity of side of effects from Covid-19 vaccine doses and higher antibody levels 1 and 6 months later. The authors of the study note that the findings could be used to educate the public about short-term, non-dangerous post-vaccine side effects, saying that clinicians might tell patients that stronger side effects could very well be “positive indications that the vaccine is likely to be working.” This is the public health messaging version of making lemonade out of lemons.

Item 3: What I’m reading: Pushing back on pandemic revisionism and bad pandemic science.

Lately, there have been some questionable op-eds in certain papers-of-record. Rather than give them much more oxygen, I thought I’d share two counter examples of science communication I appreciated this week.

1. Dr. Katelyn Jetelina’s excellent newsletter, Your Local Epidemiologist, had an excellent post about the infamous “6 foot rule” of physical distancing during the early phase of the pandemic. Critics have said that the rule lacks a scientific basis (and, oddly, blame it on Dr. Anthony Fauci, who had nothing to do with its origin). In reality, the idea almost certainly works. Whether it works a little or a lot—or what the precise right amount of separation needed to make a dent in disease transmission is—depends entirely on the specific context. But in any case, during a novel outbreak, minimizing close contact is an obvious and reasonable iteration of harm reduction.

2. One of the most aggravating things on Earth is when really bad science ends up in ostensibly good medical journals. In this week’s Health Nerd newsletter, Dr. Gideon Meyerowitz-Katz delivers an excellent analysis of the staggering cognitive and methodological errors in a study on excess mortality and Covid-19 vaccines that was somehow published in the journal BMJ Public Health. Spoiler: vaccines save lives, not the opposite.

Item 4: New Long Covid definition from National Academies of Sciences announced.

As I mentioned yesterday, whether the search for Long Covid treatments will succeed depends on nitty-gritty details like the specific definition of the disease. This week, the National Academies of Sciences, Engineering, and Medicine Long Covid workgroup released its new definition for the condition. The new definition states “Long COVID (LC) is an infection-associated chronic condition that occurs after SARS-CoV-2 infection and is present for at least three months as a continuous, relapsing and remitting, or progressive disease state that affects one or more organ systems.”

There are more details, but basically the definition is incredibly inclusive. I spoke to several Long Covid researchers and experts this week. They each told me (privately), that they understand the committee’s decision to adopt a broad definition, but that, as I argued, it could actually hinder Long Covid research because the lack of specificity might make it difficult to rigorously study the condition(s).

Item 5: Poll of the Week.

Here are the results from last week’s poll.

Item 5a: Poll of the Week for this week!

This week, Moderna announced that its two-in-one Covid-19 and influenza vaccine worked well in a clinical study. If the option comes to market in 2025, would you prefer it? Let’s find out…

Please chime in with your more nuanced answers in the Comments sections.

That’s it. Your “Friday Five!”

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