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Wegovy is covered for the cardiovascular indication (CVD plus overweight or obesity) following the CMS coverage update in March 2024, not for weight loss alone
Researchers hypothesized that, while the increased thyroid hormone increased carnitine synthesis, it also accelerated mitochondrial fatty acid oxidation (similar to what was seen to happen in a hyperthyroid state), which reduced carnitine levels
This rapid degradation occurs primarily through the enzyme dipeptidyl peptidase-4 (DPP-4) and neutral endopeptidase (NEP 24.11), along with renal clearance
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