Ozempic is about to become old news

Suddenly, Ozempic is everywhere. The weight-loss drug that contains it, semaglutide, is an effective treatment for obesity, and Hollywood and TikTok celebrities have turned it into a sensation. In just a few months, the drug has been hailed as “revolutionary” and a “game changer”, with the power to change society’s perception of obesity and thinness forever. Of course, a drug like semaglutide can be all of those. Never in the history of medicine has anyone so safely produced such dramatic weight loss in so many people.

But let’s not get ahead of ourselves. As weight loss drugs go, Ozempic is far from perfect. Although the drug has profound effects, it requires weekly injections, tolerance of uncomfortable side effects, and endurance of long-term treatment, not to mention a budget. (Ozempic has somehow become a catchall term for semaglutide, but technically the product only received FDA approval as a diabetes drug. A higher dose of semaglutide, marketed as Wegovy, is approved for weight loss.)

Semaglutide, made by Danish drugmaker Novo Nordisk, dominates the US weight loss market right now, but its reign may be short-lived. The huge demand for these drugs has fueled competition in the pharmaceutical industry to develop stronger and more potent drugs. The first of these could be available as early as this summer. For all its hype, semaglutide is the starting point, not the final destination, of a new class of anti-obesity drugs. How well they get, and how quickly, will be crucial to determine if this pharmaceutical revolution actually lives up to its promise.

In one sense, semaglutide is hardly a major breakthrough in science. Diet drugs are nothing new, and even the category of drugs that these new products belong to, called “GLP-1 agonists,” has been around for several years. These drugs mimic the hormone GLP-1 (glucagon-like peptide one) and bind to its receptor in the body. This causes the feeling of fullness associated with just eating, and also slows the release of food from the stomach. (It also increases insulin secretion, keeping blood sugar in check, which is why Ozempic is still prescribed as a diabetes drug.) Already, these drugs have gotten better over time; a daily injection called liraglutide and sold as Saxenda has been approved by According to the FDA in 2014, obesity results in a loss of 5 to 10 percent of a person’s body weight in most cases. But one reason to eliminate semaglutide is that it can lead to weight loss. 20 percent. “Now that you’re vaccinating once a week instead of every day, you make dramatic improvements and people notice more,” Angela Fitch, president of the Obesity Medicine Association and chief medical officer of the Obesity Care Initiative. up Knownwell, told me.

But not everyone who takes these drugs can achieve that level of weight loss. More than 60 percent of Wegovy patients experience smaller changes, in part because the drug can’t account for the complex factors of obesity that aren’t related to food. The next generation of drugs aims for more. The first leap forward is Mounjaro, known generically as tirzepatide, a diabetes drug from Eli Lilly that is expected to be approved by the FDA for weight loss this year. In one study, it caused weight loss of 20 percent or more in up to 57 percent of people who took the maximum dose. It Wall Street Journal It has recently been called the “King Kong” of slimming drugs. People living in Mounjaro tend to lose weight faster and generally have a “better experience” than those living in Wegovy, Keith Tapper, a biotech analyst at BMO Capital Markets, told me. It’s also cheaper, though by no means cheap, at about $980 for the highest-dose version, he said. Wegovy costs about $1,350 per dose.

These leaps in potency occur at the molecular level. Like semaglutide, Mounjaro mimics the effects of GLP-1, but it also hits receptors for another hormone, GIP. That leads to even more weight loss, further weakening the focus on food and potentially increasing the activity of a fat-burning enzyme, Tapper said. So-called dual agonist drugs “offer a step change” in both weight loss and blood sugar control, he added.

And why stop at two receptors when so many others are involved in hunger regulation? “This area is exploding in terms of research and testing different combinations of hormones,” which are still poorly understood, Shauna Levy, a professor of bariatric surgery at Tulane University School of Medicine, told me. Eli Lilly is developing another drug that targets three receptors. One drugmaker, Amgen, is working to “put the brakes” on the GIP receptor and “put the gas on” GLP-1, a company representative told me. Several other companies have already joined what some have called a “race” to develop the next big obesity drug, with Lilly, Pfizer, Amgen, Structure Therapeutics and Viking expected to be the frontrunners. Therapeutics, Tapper said.

The strength of underweight drugs is not the only factor that will determine the shape of their future trajectory. Wegovy and Mounjaro injections are tolerable for most people, but they are less convenient than the pill. However, making oral versions of these drugs isn’t as easy as packing everything into a capsule. Semaglutide is a molecule that is chewed in the stomach. For this reason, the pill Rybelsus semaglutide, which is already approved for diabetes, leads to much less dramatic weight loss than its injectable relative. But drugmakers are not deterred by this complication, as a pill more powerful than semaglutide would undoubtedly have many customers. In January, Pfizer CEO Albert Burla said the oral weight-loss drug was “opening up a market” that he said could eventually be worth $90 billion. Pfizer doesn’t yet have any weight-loss drugs, but is developing a twice-daily GLP-1 agonist pill. Eli Lilly is also developing the oral version. Tapper expects those drugs to be available in 2026, and a similar offering from Structure Therapeutics is likely to follow next year.

Drug manufacturers are also likely to struggle to create drugs with fewer side effects. Novo Nordisk notes that gastrointestinal problems are common with semaglutide; Stories of horrific nausea, constipation and vomiting have abounded on the Internet. As one actor said to: New York MagazineThe folks at Ozempic are “getting their minds off the ground”. More serious problems with Wegovy, such as pancreatitis, thyroid cancer, and kidney failure, are also possible but are considered rare. While nothing to scoff at, side effects tend to disappear with long-term treatment and are usually managed with a doctor’s help, said both Fitch and Levy, who routinely prescribe semaglutide to patients with obesity. It’s possible, Levy added, that people who experience truly dire consequences may be getting their drugs from shady pharmacies or even from other countries.

The fact that people are turning to over-the-counter outlets for weight loss drugs highlights their biggest problem: access. Medicare and most private insurance companies do not cover obesity medications. (Such drugs are classified as “cosmetic” by the Centers for Medicare and Medicaid Services and therefore not eligible for insurance. But there’s no guarantee that this will happen: competition usually makes the product cheaper over time, but research shows that That’s not always the case in pharmaceuticals. Even if drugs do get cheaper, they may not be cheap enough. Oral forms of these drugs, some of which may be available as early as 2026, are expected to cost about $500 a month, he said. Still unaffordable for many Americans, the cost of anti-obesity drugs could drop to about $350 a month by 2030, according to a recent Morgan Stanley analysis.

Levy estimates that the next five years will bring a “huge explosion” of next-generation obesity drugs. In that case, the market is likely to expand to accommodate different drugs of different prices and efficacies. Some people may aim to lose 20 percent or more of their body weight; some may settle for less. The market is so diverse that it is likely to “support a wide range of options,” Tapper said, such as cheaper, lower-dose oral medications for people with milder medical conditions and more expensive injections for those with more severe conditions. have serious problems. That makes it possible that medically mediated weight loss may soon become an option for more people.

No matter how much the cost of these drugs may drop, they will always go up if people pay for them out of pocket. They are intended for long-term use. When a person stops taking Wegovy, the weight tends to come right back. The current crop of weight-loss drugs are mostly maintenance drugs, like the cholesterol-busting drug Lipitor, which is taken daily to treat long-term conditions. But Lipitor, unlike other obesity drugs, is generally covered by insurance. Unless obesity drugs get the same kind of coverage, no amount of improvement will get them to deliver what Ozempic is now promising us.

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