From the Guidelines
When a patient plateaus on Zepbound, the first step is to reassess their current dose and consider increasing it if they haven't reached the maximum dose, while also optimizing lifestyle factors such as caloric intake and physical activity, as evidenced by the latest guidelines on obesity management 1. To address the plateau, several strategies can be employed.
- Reassess the patient's current dose and consider increasing it if they haven't reached the maximum dose, following the recommended schedule of increasing by increments every 4 weeks until the plateau resolves or maximum dose is reached.
- Focus on optimizing lifestyle factors by reviewing their caloric intake, as patients may have unconsciously increased their food consumption or decreased their physical activity, and recommend detailed food journaling for 1-2 weeks to identify potential issues.
- Increasing physical activity, particularly adding or intensifying strength training, can help build muscle mass which improves metabolic rate, as suggested by the mechanisms of action of antiobesity medications like semaglutide, a GLP-1 analog 1.
- Consider temporary caloric reduction by 100-200 calories daily for 2-4 weeks to overcome the plateau, taking into account the patient's individual needs and health status. It's essential to note that plateaus are normal physiological responses as the body adapts to weight loss and reduced caloric needs, so patients should understand this is an expected part of the weight loss journey, and with patience and the right strategies, progress can be resumed. If these approaches fail after 8-12 weeks, consider consulting with an obesity medicine specialist to evaluate for other contributing factors or to discuss additional medication options that might complement Zepbound's effects, as the FDA indication for antiobesity medications like semaglutide is for chronic weight management in adults without T2D, with a BMI ≥ 30 kg/m² or BMI ≥ 27 kg/m² with significant complications 1.
From the Research
Patient Plateau on Zepbound
There are no research papers to assist in answering this question as the provided studies do not mention Zepbound.
Alternative Treatments
However, the studies do discuss alternative treatments for chronic obstructive pulmonary disease (COPD) and asthma, such as:
- Fluticasone furoate/umeclidinium/vilanterol (FF/UMEC/VI) 2, 3
- Budesonide/glycopyrrolate/formoterol fumarate (BUD/GLY/FORM) 3
- Fluticasone propionate/salmeterol (FP/SAL) 4, 5
- Fluticasone furoate/vilanterol (FF/VI) 6, 4, 5
Key Findings
Some key findings from the studies include:
- FF/UMEC/VI was non-inferior to FF/VI + UMEC in terms of trough FEV1 change from baseline at 24 weeks 2
- FF/UMEC/VI was associated with a lower rate of moderate-severe COPD exacerbations compared to BUD/GLY/FORM 3
- FF/VI demonstrated significant improvements in pulmonary function with a prolonged duration of action in patients with COPD 6
- Initiating FF/VI was significantly better than continuing with FP/SAL for improving asthma control and quality of life, and reducing asthma exacerbations 4
- Once-daily FF/VI provided FEV1 improvement in COPD that was at least comparable with that conferred by twice-daily FP/SAL 5