Wednesday Shorts: Chemotherapy timing, GLP-1s and sleep apnea, and psychedelics

July 3, 2024

1. Earlier chemotherapy after colon cancer surgery improved prognosis

A report in JAMA Surgery showed that those who started chemotherapy within eight weeks had statistically significantly longer disease-free survival. Insurance plans should be sure that their prior authorization requirements do not unnecessarily delay initiation of chemotherapy.

2. Tirzepatide improves sleep apnea in those with obesity

A study published in the New England Journal of Medicine last week demonstrated that those on tirzepatide had dramatic improvements in their sleep apnea compared to those on placebo. This was a large, randomized study (469 patients) half of whom received placebo. Adherence to this medication for 52 weeks (88%) was higher than adherence to the placebo (72%). This finding could increase pressure on employers to provide coverage for GLP-1 medications for obesity and could mean that Medicare will start allowing Part D plans to cover this medication for those with obesity and sleep apnea.

3. Early study shows oral ketamine effective for depression

We need better treatments for depression, as many people get little benefit from currently available medications. Psychedelics are likely to be the next effective category of medications. Esketamine (Spravato), a nasal drug related to ketamine, is FDA-approved and effective, although the drug is expensive and must be given under a provider’s supervision. An FDA advisory panel gave thumbs down to MDMA for depression and post-traumatic stress disorder earlier this month, although further research might lead the FDA to reconsider.

Nature Medicine reported this week that among 168 who had initial positive response to extended release ketamine, those randomized to the highest dose for fourteen weeks were more likely to remain on the medication than those on placebo or lower doses and were twice as likely (48% vs. 24%) to report remission of depression symptoms.

This is a small study, but a promising sign for the future of psychedelics for those with treatment-resistant depression.

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Illustration by Dall-E

No Employer Coverage newsletter on July 4-5; hope you have a wonderful holiday and weekend.