Semaglutides and sleep (and diabetes and …???)

You’d have to be living under a rock not to know what semaglutides are these days. (Tell that to Microsoft Word, though – it didn’t tell me my initial spelling of semaglutides – semi vs. sema – was wrong.) Semaglutides, of course, are the new weight loss medications that go by brand names like Wegovy, Ozempic and Rybelsus. It’s hard to keep track of which celebrities have been on it, are on it or are denying being on it.  

But I’d be lying if I weren’t surprised to hear semaglutides, or GLP-1s as they’re also known, mentioned during the recent conference call to discuss ResMed’s fourth quarter and fiscal year-end financial results. It came up when an analyst asked the following question: 

“There’s obviously the debate out there on GLP-1s, maybe from the perspective of ResMed, how do you see the GLP-1 phenomenon playing out in the sleep space, specifically do you expect to gain more patients from GLP-1s versus maybe certain patients that would fall out of the funnel?” 

Here’s the answer from ResMed Chairman and CEO Mick Farrell: 

“So, I think there are three factors that’ll mitigate GLPs in the space. One is cost, two is adherence, and three is side effects. I’ll take them really quickly in order. 

“If you look at cost, take a 40-year-old person who’s on therapy full time for 40 years, 40 times, 12 times $1,000 is $480,000 lifetime cost for that patient on a GLP-1 from 40 to 80 lifetime cost. If you take that same patient and say, Look, let’s treat them with CPAP, right? First year maybe $1,000, and then 39 years of let’s take a really strong case where you get four masks a year and they’re all full-face masks, that’s about $13,500. So, it’s 35 times more expensive to go with a GLP-1. It’s just like, what’s the ROI here? 

“On adherence, the data out there are about 33% adherence at one year through the clinical trials on GLP-1s. That’s incredibly low. We get 87% adherence at 90 days, and we hold it pretty strong there. So, I think adherence is a big deal. 

“And third is side effects. Reading thyroid, pancreas, kidney, these cancers, these major side effects and minor ones like nausea, constipation, and pain. Our biggest side effect is, President Biden had a little mark on his face and he was asked about it, and it was from his CPAP. 

“Look, I think it’s a long road to play out here. I think it’s frankly good marketing around the area of obesity and it can drive patients into the funnel. But I don’t think it’s going to be a major impact on patients because we’ve got 936 million of them worldwide and we need them to get into the funnel. If they come in the funnel because they tried a pill and it didn’t work, that’s good for us, too.” 

To recap, Farrell doesn’t believe semaglutides will dampen the demand for CPAP therapy any time soon because the drugs are costly, they don’t result in good adherence, and they can have serious side effects. 

But the fact that the question is even being raised, while it was initially weird to me, now makes all the sense in the world. 

I mean, according to the latest research, obesity is among the most important risk factors for sleep apnea. Studies have consistently found an association between increased body weight and the risk of sleep apnea. Significant sleep apnea is present in about 40% of obese individuals, and 70% of sleep apnea patients are obese. 

So, I think what that analyst was really asking was, if semaglutides are used to eliminate obesity, are they also eliminating the need for CPAP therapy? 

There’s one thing I’m not surprised about: That Farrell wasn’t surprised by the question and that he had a well-thought-out answer at hand. They don’t pay him the big bucks for nothing, as they say. ResMed has proven that it’s not sticking its head in the sand when it comes to evolving therapies. In the U.K., it even offers an oral device that treats sleep apnea called Narval CC. 

By the way, semaglutides could potentially impact other product categories in the HME industry, namely diabetes. It’s ironic that these drugs, which were formulated to treat diabetes, are now a potential way to avoid diabetes. 

If you’re in the HME industry, it’s nothing to worry about now, but food for thought for sure.