Tirzepatide (Zepbound)

Canada’s Drug Agency (CDA-AMC) recommends that Zepbound be reimbursed by public drug plans for once-weekly administration as an adjunct to a reduced-calorie diet and increased physical activity, to treat moderate to severe obstructive sleep apnea (OSA) in adults with obesity (body mass index [BMI] 30 kg/m2 or greater) if certain conditions are met. The Canadian Drug Expert Committee (CDEC) determined that Zepbound demonstrates acceptable clinical value versus lifestyle modification alone or lifestyle modification and positive airway pressure (PAP) in adult patients with OSA and obesity. This determination was enough for CDEC to recommend that Zepbound be reimbursed. Given that Zepbound is expected to be an additive treatment to these interventions, acceptable clinical value refers to added value versus lifestyle modification with or without concurrent PAP. Evidence from 2 clinical trials showed that Zepbound improved apnea-hypopnea index (AHI) versus placebo in people with OSA and obesity and likely resulted in clinically meaningful reductions in body weight and blood pressure compared with placebo. In addition, a greater proportion of patients achieved OSA remission with tirzepatide than with placebo. CDEC considered OSA remission to be a clinically meaningful outcome because it captures improvements in both OSA severity and daytime sleepiness and represents a more comprehensive treatment target. Remission may also reduce or eliminate the need for PAP therapy, an outcome that is important to patients.