New Innovations in GLP-1 Therapy, with Adam Mendelsohn, Ph.D.

There is no denying the growing impact of glucagon-like peptide-1 (GLP-1) receptor agonists, originally developed for Type 2 diabetes but now widely used for weight loss. In an interview with The Educated Patient, Adam Mendelsohn, Ph.D., co-founder and chief executive officer at Vivani Medical, explains that these drugs work by amplifying insulin response and influencing brain pathways that control appetite. Over time, pharmaceutical companies discovered that higher doses led to significant weight loss, which has driven their popularity.

“The current belief around why this is happening is because the GLP-1s are accessing parts of the brain which control appetite, and this causes people to be less hungry so they consume fewer calories, and as a result, they end up losing weight,” he says.

GLP-1 medications not only reduce hunger but also slow gastric emptying, which contributes to a prolonged feeling of fullness. However, this mechanism also explains common gastrointestinal side effects like nausea, particularly when patients start treatment or increase their dose. Beyond weight loss, these drugs have shown cardiovascular benefits and may even have potential applications in curbing cravings for substances like opioids, though Mendelsohn says more research is needed.

A major challenge with GLP-1 therapy is adherence. If patients stop taking the medication suddenly, they often regain weight quickly, sometimes at even higher rates than before. Mendelsohn explains that a biological “starvation response” can trigger increased food consumption when the drug is discontinued. Additionally, if patients resume treatment after missing a few doses, they may experience intensified side effects. This highlights the importance of consistent and gradual dosing adjustments.

Currently, all available GLP-1 treatments require weekly injections, but adherence remains an issue, with only 50% to 60% of patients maintaining the recommended dosing. To address this, companies like Vivani Medical are developing a six-month implant to ensure steady drug delivery. This option may be particularly attractive to patients seeking long-term treatment without the burden of frequent injections.

Despite supply challenges due to high demand, GLP-1s represent a groundbreaking advance in weight management and metabolic health. According to Mendelsohn, future developments focus on improving tolerability, preserving lean muscle mass during weight loss and making treatments more accessible. He emphasizes that while GLP-1s are highly effective, patients should work closely with their physicians to ensure safe and sustained use for long-term benefits.