Primary care NP, lover of glucagon agonism, incretin nerd, photographer, mountain lover, coonhound rescuer
Primary care land
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Not designed for weight loss. Test low doses for phase 1. Still causing significant weight reductions in 11 weeks and with minimal GI side effects(same as placebo)
@rn_flex gives his read on all the new data on GIP for VK2735, enicepatide and Brenipatide. Flex says, “All hail the current and future GIP kings.” 👑😂
New info: Brenipatide has a half around 10 days and, even though it’s being targeted as a psych med, still shows double digit weight loss. 😲
the-incretins.beehiiv.com/p/…
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David W retweeted
@Roche notches impressive P2 data for the GLP-1R-GIPR co-co-agonist Enicepatide #T2D #weightloss roche.com/media/releases/med…
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This guy continues to just be wrong. They have the resources to do both. And yet. They won't. Same mistake as Amylin vs GIP. And if the medicare bridge has taught me anything. Patients want results & tolerance first. Convenience is usually 2nd.
LIVE: $NVO Head of R&D Martin Holst Lange says pills are the future because they are convenient for patients and do not require refrigeration.
He believes oral large-molecule drugs can offer efficacy advantages over small molecules, and Novo is exploring pills not only for obesity and diabetes but potentially also for hemophilia.
Novo is now working with the third generation of its technology for delivering large molecules orally, with each generation designed to increase the amount of active drug that reaches its target.
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We're in a revolution not only with GLP-1 meds, but also drugs that are kidney protective. We can add orforglipron an oral GLP-1 small molecule to the list of kidney protective in diabetes. The full data will be presented at EASD in 10 days. This is an eye opening graph #NephJC
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It also decreased composite kidney outcomes in the overall populations(HR 0.74 CI 0.58-0.93) and directionally similar with the high risk group (HR 0.79, CI 0.55-1.14) and 🔽 UACR by ~28% for both groups
AND "Effects on eGFR and UACR were consistent regardless of SGLT-2i use."
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Oh look another Lilly trial for Brenipatide for an oddball indication, moderate to severe COPD!
(not that odd, respiratory diseases are worsened by obesity, same drug also being studied for asthma!)
GIP & GLP1 both expressed in lung tissue + antiinflammatory effect
@JCanNuSH
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David W retweeted
🚨 The Novo Nordisk Foundation funded a very interesting trial, REACT, that is being presented this weekend as part of #ESC2026. The related paper is: “Prevalence of Silent Atherosclerosis across Adult Life.”
It found, that among adults with no known atherosclerotic cardiovascular disease:
▪️Atherosclerosis was identified in 57.1% of participants, with presence varying by age and sex
▪️In the 18-29 group, silent atherosclerosis was detectable 8.7% of
men and 6.7% of women
▪️This increased to 34.6% of men and 21.3% of women 30 to 39 years old
▪️By 60-70, only 1.9% of
men and 8.1% of women had no plaque detected in any examined territory
Their imaging looked for atherosclerosis (plaque) in both coronary and peripheral arteries.
I believe this is an attempt to start laying the ground work for coverage of semaglutide and CagriSema as a preventative CVD measure (prior to an adverse CV event) in a broader population, just as Medicare Bridge and BALANCE are enabling coverage for seniors with pre-diabetes, even though that’s not actually an FDA indication for weight loss GLP-1s at this time.
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So much of this is the opacity of PBMs and HR benefit managers not understanding there are multiple options around this. Lilly has a PBM bypass program that offers GLP1 access for $450/month for one. There's multiple other programs to reduce cost without the big 4 PBMs
Pepsi Drops GLP-1 Coverage for Employees: Will This Force a Reckoning in Zepbound and Wegovy List Pricing? $PEP $LLY $NVO nitter.net/i/broadcasts/1yJAPwqdB…
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Stopping the trial at the first interim analysis?
Whoa.
I can't wait to see this data.
🚨🚨🚨BREAKING CANCER NEWS! 🚨🚨🚨
Merck $MRK and Moderna $MRNA personalized mRNA cancer vaccine slowed the return of melanoma and its spread to other parts of the body in a Ph3 clinical trial.
No data disclosed yet, but the study was stopped for positive results at the first interim analysis.
Magnitude of benefit TBD, but this is a potentially huge breakthrough for cancer patients and the use of mRNA to treat cancer.
Read STAT's story from @matthewherper and @angRchen
statnews.com/2026/08/19/mrna…
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David W retweeted
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#NephJC #TenPostNephJC #NephTwitter
Can just 4 doses of an SGLT2i prevent AKI after cardiac surgery? The MERCURI-2 trial put dapagliflozin to the test. But is the benefit a treat or a trick?🫀💊
Read the article 👇
pubmed.ncbi.nlm.nih.gov/4253…
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David W retweeted
Here’s our (@NephJC’s) 🔥 fiery review of the MERCURI-2 trial ! What to say, the limitations seem limitless ! 😅
Probably one of the first trials I’ve read where Urine output takes up more space and value than Creatinine in the AKI equation.
Summary by @rn_flex and @DrBarbaTeba (the girl with the 🐈⬛s)
@DrPallaviPrasad @brian_rifkin @CristinaDeReins @jmteakell @assad_sm @kidney_boy @hswapnil @dra_miliflores
Dapagliflozin cuts AKI after cardiac surgery - MERCURI-2 says so. But dig into the data, and it's mostly an urine output story, not a kidney protection one
✍️ #NephJC summary by @rn_flex and @DrBarbaTeba
#nephtwitter #medtwitter
nephjc.com/news/2026/8/18/me…
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David W retweeted
Dapagliflozin cuts AKI after cardiac surgery - MERCURI-2 says so. But dig into the data, and it's mostly an urine output story, not a kidney protection one
✍️ #NephJC summary by @rn_flex and @DrBarbaTeba
#nephtwitter #medtwitter
nephjc.com/news/2026/8/18/me…
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David W retweeted
Excited for SGLT2 inhibitors to prevent AKI in CV surgery patients? So were we... until we got past the title.
This week we're talking about "that JAMA paper "🙃
#NephJC #NephTwitter
Here's the VA by @ManoleaA
nephjc.com/news/2026/8/17/me…
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One of the single most obnoxious and objectively dishonest things you can do with data.
Exaggerate the y-axis.
But I suppose when you're trying to hide that your drug has a GI tolerability issue that's one way to make it look better.
(Oh and cluster all the GI symptoms as one)
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Doubling down on calcitonin(literally half the molecule is based on calcitonin) isn't the ticket for diabetics. Too much blunting of insulin secretion, weight loss good but still tolerability issues. Martin Lange needs to be shown the door at Novo.
$NVO oral amycretin 36 wk phase 2 obese diabetics just got published in Lancet
Wt loss about 10%. ( 6 mg -50 mg ). HbA1C reduction of 1.4. So in line or slightly lower than oral sema.
Surprisingly vomit only 16% although DC rate due to AE 14% including 12% due to GI ( not just vomit but nausea and others
) … So vomit rate lower than oral sema but DC rate almost double ?
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Per Novo: “We have to be able to manufacture it in the same way as our existing medicines”
The lack of SPPS capacity is gonna increasingly become an issue for them going forward. Can't make the more complex molecules like Elora, Reta, VK2735 and even UBT251 without it.
If u believe $LLy is diversified look below
And also see what TZP is doing to $NVO business
I also think NVO got trapped with this yeast manufacturing scale up. Several poor decisions by Lange and previous management not only on choosing wrong molecules but on how to strategically plan long term.
Every time I feel excited about novo, I quickly recover😔.
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