gastric emptying glp-1 Agonist-Induced Delayed – A Clinical Pharmacology Perspective dSummary of the interdependent relationships

Biased Agonism: Does It Work?# The Evidence So Far# Two drugs in this comparison -- ecnoglutide and CT-388 -- were specifically engineered with biased agonism to improve tolerability: Ecnoglutide (cAMP-biased at GLP-1R): Discontinuation due to AEs: approximately 2%, among the lowest reported for any GLP-1 agonist Weight loss of 13.2% at 40 weeks is competitive with semaglutide-class efficacy The tolerability-to-efficacy ratio appears favorable CT-388 (signal-biased at both GLP-1R and GIPR): Despite very high Phase 1b GI rates during titration (83% nausea), Phase 2 showed only 5.9% AE discontinuation Weight loss of 22.5% at 48 weeks is among the highest in the field The tolerability-to-efficacy ratio is notable: comparable weight loss to tirzepatide with a lower discontinuation rate What the Data Suggest# The biased agonism hypothesis appears to be supported by early clinical data, though with important caveats: Biased agonists do not eliminate GI side effects -- they may reduce their severity and duration The key metric is discontinuation, not incidence -- a drug with high nausea rates but low discontinuation may indicate transient, manageable symptoms Longer and larger trials are needed -- both ecnoglutide and CT-388 have limited Phase 3 data available Patterns and Insights# More Receptors, More Side Effects# A general pattern emerges: adding receptor targets increases both efficacy and GI side effect burden

2007b;13(2):40-7 Simone CB, 2nd, Simone NL, Simone V, Simone CB

Briefings in Bioinformatics, 25 (4)

Washington State investigators found serious violations at a Mochi Health-affiliated compounding pharmacy producing GLP-1s, and a med spa bill in Indiana hears public testimony about a med spa bill

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