Orexigen, Vivus remain in weight-loss limbo

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Orexigen Therapeutics reported quarterly results yesterday, rounding out a week of obesity-related news with a broadening burn rate.

Although the San Diego company has yet to market a drug, its holding pattern is very much in line with its peers. For Orexigen, the first quarter of 2013 brought a $19.4 million net loss, compared to $10.4 million for the same period last year. The company's lead pipeline drug, Contrave, is in the midst of a cardiovascular safety study and the company is talking with the FDA about whether another slimming drug candidate, Empatic, will have to undergo similar review before filing an NDA. As with Vivus' Qsymia, Contrave has been previously rejected by FDA. Jefferies analyst Corey Davis wrote in his Wednesday research note that he expects Contrave will clear European regulators—which have twice rejected Qsymia. Arena also took Belviq out of the running in the EU this month. Davis wrote that he is in “wait and see” mode on just how the field is going to shake out. Arena got the all-clear to market its drug in the US this week.

Vivus also posted earnings Wednesday. Despite revenues of $4.1 million for the first quarter and the recent approval to expand its distribution to include retail in addition to mail-order pharmacies, the company has been struggling to get payer buy-in. Attempts to lure patients with a starter dose have failed to goose sales, and the company has been criticized for its focus on keeping its marketing in-house. The most recent promotional push—which included a weight-loss app—was being marketed by the same team of 150 reps, and, despite its consumer appeal, was not being widely promoted beyond the doctor's offices. The company said Wednesday that it is looking into securing an outside marketing partner, but Jefferies analyst Thomas Wei's Thursday research note indicates that this business move is not enough to make him go all-in for the drug. Wei is disappointed in the prescription growth, saying the quarter's 59,000 prescriptions remains “a highly linear trajectory... with no sign of acceleration.” He is also skeptical of the impact the retail distribution channel can have on sales, due to “a mosaic of other issues, including lack of physician awareness and physician misperceptions of obesity drugs. . .and the expected entrance of competitor Belviq in June."

Recent studies have also shown that the barriers go beyond the drug's potential physical and financial impacts and can be negatively affected by the interactions between patients and doctors even before weight is discussed.

A small study published in the February issue of Obesity found that doctors failed to make an emotional connection with obese patients akin to the one developed with patients who were within the parameters of a healthy body mass index. Among the 42 urban, community-based primary care physicians surveyed, researchers found that not only were overweight and obese patients “known less well by their physicians as their normal weight patients,” but that physicians also had less respect for their obese patients, perceiving them as being non-adherent and lazy. They also noted that despite the number of co-morbid conditions associated with obesity “physicians in our sample did not spend  more time with obese patients or engage with them in more biomedical communication to address multi-morbidity.”

Researchers say the concern is that emotional support—which includes empathy and reassurance—has been linked to better patient adherence and a greater likelihood to change dietary habits and to attempt to lose weight.

That respect deficit flows both ways. Obesity published another study in March that showed “patients responded negatively to excess weight among health providers.” They noted that they could not conclude that seeing an overweight doctor resulted in less adherent patients, but did say the findings indicate that “providers' excess weight may negatively affect patients' perceptions of their credibility, level of trust and inclination to follow medical advice.”

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