Ahhhh #NephSky the retatrutide trial to see if it increases GFR is completed!! Now we wait for Lilly to announce results...I think the nephrology world is in for a big surprise in 2026 🤞

Ahhhh #NephSky the retatrutide trial to see if it increases GFR is completed!! Now we wait for Lilly to announce results...I think the nephrology world is in for a big surprise in 2026 🤞

#NephSky and #NephJC in what capacity do we expect the kidney to be able to repair the nephron and glomeruli? Like is there a point in CKD where any reversal of damage is impossible? I presume if it's fibrotic then it's too late? But before that point, recovery is technically possible?

At first blush, great results, however, no mention of side effects and earlier Ph2 data showed this drug is rough on the GI tract. 60% nausea 30% vomiting. That's not 'tolerable' by any stretch. I'll be curious what the actual side effects are when published.

Andor season 2 was just 4 actually good Star Wars movies chopped up into shorter episodes.

We'll see what the raw data shows but this was a moonshot trial regardless. If there's signs of progress I'd honestly hope someone tries again but with an injectable to get more steady blood levels of whatever drug. Regardless dementia is a tough disease to crack. Appreciate they tried.

2 years ago on a whim I planted the crown of a pineapple we bought from the store. In the last week it's finally showing signs it's about to bloom and create another pineapple!

Had leftover sloppy joes and decided I'd turn them into nachos. 8/10. Especially good with raw onion and pickled jalapenos.

If you work as a primary care provider or really any medical speciality provider having your Epic in basket look like this is 🤌🤌 Savoring the fact that it'll look like this for maybe 30 minutes

8 years ago I was here. Fakarava in French Polynesia. One of the most magical places I've ever been in my life.

NOOOOO Dragon dictation software is down because of the Cloudflare outage. This is going to be hell trying to document today 🫣🫣😭😭

Pulmonary medicine and Neurology/addiction medicine come on down. It's your turn for GLP1 medications! Eli Lilly(again!) has a new GLP1/GIP dual agonist on phase 2 & 3 trials for alcohol use disroder, smoking cessation and moderate asthma! @ryanmarino.bsky.social @proptermalone.bsky.social

Want some dirt on the newest obesity medicines in development? I did a whole article on 5 new GLP-1 or Amylin agonist drugs and the benefits, and pitfalls on the data so far

I had a blast at Obesity Week 2025 & multiple new drugs were discussed there. I picked out 5 of the most promising & prominent meds to deep dive on! These include Orforglipron, Eloralintide, Mazdutide, MET-097 & HRS-9531 The GLP1 space is jam packed with exciting new developments!

MY PATIENT IS GETTING A NEW LIVER TODAY. I'M WEEPING Y'ALL 🎉😭🎉😭🎉

I had a blast at Obesity Week 2025 & multiple new drugs were discussed there. I picked out 5 of the most promising & prominent meds to deep dive on! These include Orforglipron, Eloralintide, Mazdutide, MET-097 & HRS-9531 The GLP1 space is jam packed with exciting new developments!

Always read the supplementary appendix because you find buried treasure. Phase 2 Eloralintide data from Eli Lilly ⏬ Aldosterone ⏬ UACR ⬆️Renin And increased GFR over 48 weeks. What the heck is going on #NephSky?! First it was Glucagon agonism and now Amylin may have some renal effect too?!

Always read the supplementary appendix because you find buried treasure. Phase 2 Eloralintide data from Eli Lilly ⏬ Aldosterone ⏬ UACR ⬆️Renin And increased GFR over 48 weeks. What the heck is going on #NephSky?! First it was Glucagon agonism and now Amylin may have some renal effect too?!

Why is Eli Lilly a juggernaut?? It's at least in part because of this man, David Ricks. Fascinating 2 hour listen about GLP1 meds, the fact that Lilly expects to spend more money on R&D than the NIH in 2 years time(!!!), patient access, cost and more.

One of my patients got accepted onto the Transplant List for their particular organ. I'm so excited for them! We've been working towards this goal for 6 months now and finally got accepted today! 🎉🎉 (It's still a long shot but it's a huge milestone and gives hope!)

So gonna tag in some of #NephSky. There's an apparent class effect for GLP1 RA to potently lower BP in patients with existing hypertension. Seen here is orforglipron which Lilly is now trialing for high blood pressure(!!) @littlebiggloms.bsky.social @brianrifkin.bsky.social @hswapnil.medsky.social

CC: @mikejohansenmd.medsky.social In what might be one of the hilariously beneficial Kaplan Meier curves I've ever seen. TTE study of GLP1 meds and alcohol use disorder with the top left graph being incident of alcohol use tirzepatide vs DPP-4i dom-pubs.onlinelibrary.wiley.com/doi/full/10....

Primary care is really really hard most days. But when you get notes like this. It makes everything worth it.

Another day another telmisartan and tirzepatide combo prescribed. It's like the Konami cheat code combo for dyslipidemia, high blood pressure and obesity +/- diabetes.

We invented the most powerful weight loss drug ever and it might be an effective oncology drug too 😳🤯 "Low-dose RETA significantly reduced tumor volume by 3-fold compared to vehicle, demonstrating efficacy comparable to anti-PD-1 therapy, which achieved a 5-fold reduction in tumor volume"

This is an "oof" result. Triglycerides and acute pancreatitis decreased. *Waves tiny flag* But increased fatty liver disease and 60%(!!!!) increase in LDL cholesterol. Yikes. @mikejohansenmd.medsky.social tell me I'm reading this wrong? I don't think I am 😳

I want to believe. No benefit from GLP1 meds for movement disorders, but in this retrospective cohort there *is* a clear signal for a possible dementia benefit?! Maybe? Maybe? First RCT on this question should have topline data in the next month or two

Chattanooga Whiskey again with the amazing stuff. Bourbon x Limecello. It's like a sour key lime pie in a bottle in the best way. Great way for me and the wifey to relax after a long week for us both

Addendum: The number of visibly and audibly sick people on the plane without a mask kinda sucks. Protect your fellow humans! Please?!

Once again I'll say if you buy a window seat on a plane and then immediately close the window shades on a cloudless autumn day where we're gonna fly over mountains you don't deserve a window seat! Be amazed by the beauty of the world at 30,000 feet!!

Last day and literally the last lecture that I attended. Eli Lilly with Mazdutide(GLP1/Glucagon)Phase 2 dose finding study. 16mg dose is not viable. Too many side effects. But the 10mg dose. Viable. Nearly 20% weight loss without plateau. 20% reduction in LDL cholesterol. Onward to phase 3 now.

Last day in Atlanta and I'm about to treat myself with some pain au chocolat y'all

Retatrutide does some crazy amazing things. Congrats Dr E!

*low whistle* 16-20% weight loss, no plateau at 48 weeks I'd hate to be working for Novo Nordisk today 😳

Some big Retatrutide news! Triumph 3, which is Retatrutide + existing CVD + severe obesity(BMI>35) has been halted 16 weeks earlier than planned. Primary endpoint was 80 week weight loss 2nd endpoint was cardiovascular events & was allowed to run for up to 104 weeks for CV event reporting🧵

To be more clear on this. Tirzepatide via GIP is insulin sensitizing. Telmisartan is a partial PPAR-Y agonist that also increases insulin sensitivity. Both drug alter lipid levels as well, also probably synergistically. Telmisartan is also a great blood pressure med too.

Me: I wonder why Lilly is running trials for orforglipron (oral GLP-1 med) for hypertension?? Sees this slide today at Obesity Week: OH. (that placebo reduction is presumably rescue therapy of prescribing traditional blood pressure meds) So yeah impressive reductions.

Ahhh PPAR-GAMMA is synergistic with GIP agonism! All my tirzepatide patients are about to get telmisartan!! Ahhh(sorry nerd moment I had to share, I've suspected this, but apparently it's true*) *In mice (but should work in humans too)

Maybe it's the nerd in me but this display at the Lilly booth is mesmerizing. It's the 3D structure of all their cardiometabolic molecules in developments. Peptides, small molecules, MABs, and siRNA(the alien tentacles on the top left)

Just a call out to smart women helping the entire world. This is Lotte Bjerre Knudsen. She invented liraglutide and co-invented semaglutide. She is one of the biggest reasons we have effective anti obesity medications. And her sense of style for this talk is 🤌

Surreal moment last night. Being questioned by a big pharma science team on glucagon agonism and how to sell it to the general public and especially clinicians who were taught for decades that glucagon and diabetes is bad all because of this blog post I did over the summer:

Today's obesity week agenda! More kidney stuff! First talk is by someone who might win a Nobel prize one day(she led the development of liraglutide and then semaglutide, arguably without her we aren't talking GLP1 meds like we do now! Then kidney and CagriSema stuff!

While there were a lot of cool displays at Obesity Week this one was really cool. 3D structures of all of Eli Lilly's cardiometabolic molecules in development. They slowly rotated(sorry didn't get video) but very cool to see the differences in small molecule vs peptide vs siRNA drugs

Why do people have trouble losing weight in 2025? Well there's a few reasons. We live in a time of abundance and convenience. We've created an environment where our body's regulators become overwhelmed and we gain weight. #OW2025

This one is for #Nephsky from #OW2025 outcomes in dialysis patients starting GLP1 medications specifically looking at wait listing for transplant and for mortality reductions so what did they find? They used renal data from Medicare claims to examine this

My #OW2025 schedule today, Slightly overbooked but, liver and kidney disease to start then neurobiology, dose de-escalation for maintenance, then NA-931(which is a scam/fake drug?!! More on that later) and finally finish with cancer and obesity and finish with poster session.

The interaction of GLP-1 medicines with the immune system is complex, enabled by direct and indirect actions, including neural inter organ communication. These studies have been led @SinaiHealth by CK Wong. His latest perspective here in the JCI www.jci.org/articles/vie...

#OW2025 so excited for the next few days!

It's time for Obesity Week 2025!! So excited to get my learning on!

I can't explain the mechanism beyond maybe some sort of immune modulation? But I know I don't get sick very often in the last 2+ years of being on a GLP-1 medications.