The media is abuzz with claims of a new breakthrough treatment for sleep apnea. A recent international clinical trial suggests that tirzepatide, a pharmacological treatment, could be a game-changer for those suffering from this condition. Published in the New England Journal of Medicine (NEJM) on June 21, 2024, the SURMOUNT-OSA phase 3 trial has shown promising results in treating adults with obstructive sleep apnea (OSA) and obesity.
The trial’s ambitious design and impressive outcomes have led to headlines proclaiming that tirzepatide can cure sleep apnea. However, the drug’s success is largely due to its effectiveness in treating obesity, which is a major cause of sleep apnea. Essentially, tirzepatide helps alleviate sleep apnea by addressing the underlying obesity (this is obvious, but not discussed in the paper).
There is a flaw in the design. It’s clear to every professional in the field that it “cures” sleep apnea because it “cures” obesity, and that benefit is therefore mediated: we already knew it is associated with weight loss. If the aim was to demonstrate its benefit for sleep apnea specifically, a more logical design would have compared patients with OSA and obesity to patients with OSA without obesity. However, such a design probably wouldn’t have yielded the desired outcomes.
I am not fully versed in the pharmacological details and have mostly heard about tirzepatide through the news. However, the press coverage on sleep apnea caught my attention. It’s undeniably good news to have something effective against diabetes and obesity, given that obesity is likely the number one health concern in developed countries. It is also directly or indirectly responsible for a significant portion of healthcare costs (including those related to OSA). So, both, semaglutide (Wegovy, Ozempic), and tirzeparide (Mounjaro) are basically good news for patients (though a management nightmare).
OSA is a complex disease requiring a personalized approach for each patient. In cases where patients have both OSA and obesity, addressing obesity is crucial as it is often the primary cause of OSA. Treating obesity is itself a complex process, and every healthcare professional knows that lasting success relies on lifestyle modifications (including dietary habits). Without these changes, both obesity and OSA are likely to recur.
Is the idea to have patients with OSA (or obesity) indefinitely on tirzepatide?
J Granell. June 29, 2024
PD. Studies on safety and efficiency of long term use are sure to follow