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Letters to the editor

Effective but inaccessible antiobesity medications

Sima Saberi, MD, Sabiha M. Hussain, MD, Mohammad Kazem Fallahzadeh, MD, MAS, Hector Madariaga, MD, Pooja Budhiraja, MBBS and Kenneth J. Woodside, MD
Cleveland Clinic Journal of Medicine March 2025, 92 (3) 141; DOI: https://doi.org/10.3949/ccjm.92c.03001
Sima Saberi
Clinical Assistant Professor, Division of Metabolism, Endocrinology & Diabetes, Department of Internal Medicine, Michigan Medicine, Ann Arbor, MI
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Sabiha M. Hussain
Associate Professor, Renal-Electrolyte and Hypertension Division, University of Pennsylvania, Perelman School of Medicine, and Penn Kidney Pancreas Transplant Program, Philadelphia, PA
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Mohammad Kazem Fallahzadeh
Assistant Professor, Section of Nephrology, Wake Forest University School of Medicine, Winston-Salem, NC
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Hector Madariaga
Clinical Assistant Professor, Department of Transplantation, Tufts Medical Center, Boston, MA
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Pooja Budhiraja
Associate Professor, Transplant Center, Division of Nephrology and Hypertension, Mayo Clinic, Phoenix, AZ
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Kenneth J. Woodside
Academia Invisus, LLC, and Sharing Hope South Carolina, Charleston, SC
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To the Editor: We read with great interest the commentary on improving access to antiobesity medications by Dr. Burguera and colleagues published in the November 2024 issue.1 This article highlighted the plague of unequal and inadequate access to the new glucagon-like peptide (GLP) 1 and dual glucose-dependent insulinotropic polypeptide and GLP-1 receptor agonist medications for weight loss. We would like to echo and highlight the lack of access to these medications in patients awaiting organ transplants.

Obesity is a leading risk factor for chronic kidney disease, metabolic dysfunction–associated steatotic liver disease (formerly known as nonalcoholic fatty liver disease), and congestive heart failure. Studies have shown that patients with obesity have a lower likelihood of being listed and undergoing a kidney transplant.2 There are about 90,000 patients awaiting a kidney transplant, and 17 people die each day in the United States while awaiting an organ transplant.3 Obesity in patients who have undergone renal transplant has been associated with a higher risk of delayed graft function, wound dehiscence, allograft rejection and loss, posttransplant diabetes, and cardiovascular disease.2,4

Burguera and colleagues1 outlined the cost differences for these medications between countries, with individuals in some countries paying as much as 75% less for them. Insurance coverage and pricing in the United States have amplified the inequalities in access in our healthcare system, as some insurance companies have limited their coverage and expanded prior authorization requirements in an effort to reduce the number of patients eligible for these medications.5 This further exacerbates disparities in access to solid-organ transplants, and particularly affects those who are already at a disadvantage in our healthcare system.

We add our voices to those of Dr. Burguera and colleagues1 in a call to action to expand coverage and affordability of these medications as our patients’ lives are at stake.

  • Copyright © 2025 The Cleveland Clinic Foundation. All Rights Reserved.

REFERENCES

  1. ↵
    1. Burguera B,
    2. Griebeler ML,
    3. Garvey WT
    . Effective but inaccessible antiobesity medications: a call for sharing responsibility for improving access to evidence-based care. Cleve Clin J Med 2024; 91(11): 671–676. doi:10.3949/ccjm.91a.24068
    OpenUrlFREE Full Text
  2. ↵
    1. Oniscu GC,
    2. Abramowicz D,
    3. Bolignano D, et al
    . Management of obesity in kidney transplant candidates and recipients: a clinical practice guideline by the DESCARTES Working Group of ERA. Nephrol Dial Transplant 2021; 37(suppl 1):i1–i15. doi:10.1093/ndt/gfab310
    OpenUrlCrossRefPubMed
  3. ↵
    1. Health Resources & Services Administration
    . Organ donation statistics. Updated October 2024. https://www.organdonor.gov/learn/organ-donation-statistics. Accessed February 14, 2025.
  4. ↵
    1. Kwan JM,
    2. Hajjiri Z,
    3. Metwally A,
    4. Finn PW,
    5. Perkins DL
    . Effect of the obesity epidemic on kidney transplantation: obesity is independent of diabetes as a risk factor for adverse renal transplant outcomes. PLoS One 2016; 11(11):e0165712. doi:10.1371/journal.pone.0165712
    OpenUrlCrossRefPubMed
  5. ↵
    1. Advisory Board
    . Daily Briefing: The cost of weight-loss drugs is putting some insurers off. Updated August 7, 2023. https://www.advisory.com/daily-briefing/2023/08/07/weight-loss-coverage. Accessed February 14, 2025.
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Cleveland Clinic Journal of Medicine: 92 (3)
Cleveland Clinic Journal of Medicine
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1 Mar 2025
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Effective but inaccessible antiobesity medications
Sima Saberi, Sabiha M. Hussain, Mohammad Kazem Fallahzadeh, Hector Madariaga, Pooja Budhiraja, Kenneth J. Woodside
Cleveland Clinic Journal of Medicine Mar 2025, 92 (3) 141; DOI: 10.3949/ccjm.92c.03001

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Effective but inaccessible antiobesity medications
Sima Saberi, Sabiha M. Hussain, Mohammad Kazem Fallahzadeh, Hector Madariaga, Pooja Budhiraja, Kenneth J. Woodside
Cleveland Clinic Journal of Medicine Mar 2025, 92 (3) 141; DOI: 10.3949/ccjm.92c.03001
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