It is the most notable scientific advance of 2023 by Science magazine and the goose that lays the golden eggs for several pharmaceutical companies, especially Novo Nordisk, a Danish laboratory that has become the most valuable company in Europe. We are talking about the latest generation drugs to fight obesity, which imitate the action of the GLP-1 hormone and have been shown to be very effective in losing weight. Their demand is such - driven in part by the dissemination of their benefits that Hollywood stars or other celebrities, such as Elon Musk, have made on social networks - that there are currently shortages in many of them. And that has its consequences. Without going any further, for patients with type 2 diabetes. It was for this pathology that they were initially developed, although later it was seen that they were very efficient in treating obesity. In Spain, most of the marketed presentations (Ozempic, from Novo Nordisk, is the star) are indicated only for diabetes. However, there are doctors - especially in private healthcare - who prescribe them for weight loss. Result? They are conspicuous by their absence in many pharmacies, a problem that could continue into 2024, according to sources from Novo Nordisk explained to La Vanguardia.
“Ozempic [with semaglutide as an active ingredient] is not the only drug that suffers from shortages. All medications from the same family have this problem,” explains Antonio Pérez, unit director of the endocrinology and nutrition service at the Sant Pau hospital and president of the Spanish Diabetes Society. “And there is also a lack of stock of Victoza (liraglutide) and Trulicity (dulaglutide). All three, which are injectable, are indicated in Spain exclusively for patients with diabetes.”
The only one in this family of drugs that is currently authorized for weight loss in Spain is Saxenda (also from Novo Nordisk), which, like the rest, has supply problems. It also happens that it is more expensive than Ozempic. The latter, with a private prescription, costs around 130 euros for a one-month treatment, while Saxenda reaches 280 euros. “For this reason, people who consumed Saxenda have switched to Ozempic,” says Antoni Torres, president of the Federation of Pharmacy Associations of Catalonia (Fefac). The equivalent of Ozempic indicated for weight loss already exists on the market (it is Wegovy, also from Novo Nordisk, with the same active ingredient although a different dose), but it is not yet marketed in Spain.
Despite belonging to the family of GLP-1 agonist drugs, Ozempic and Saxenda have different active ingredients (semaglutide for the first; liraglutide for the second). “Liraglutide is first generation (it has been on the market for years), while semaglutide is much more recent and generates greater benefits,” says Dr. Núria Vilarrasa, specialist in endocrinology and nutrition at the Bellvitge hospital.
The numbers show it. With Saxenda you lose between 5% and 6% of your initial weight in about two months, as long as its intake is accompanied by physical activity and a healthy diet. “Once you reach that point, there is maintenance if you continue taking the drug,” argues Vilarrasa. With semaglutide, weight loss is even greater. “There are studies, with Wegovy, carried out with obese people without diabetes where the reduction is estimated at approximately 16%, also with a healthy diet and physical activity. It is much more powerful,” she adds.
In addition to stimulating the pancreas to secrete insulin, these drugs slow gastric emptying, thereby increasing the feeling of fullness. And not only that. They act at the level of the central nervous system, so that they help reduce the feeling of hunger. They also reduce the risk of cardiovascular accident by up to 20%.
Hence, endocrinologists and nutritionists, especially in private healthcare, are prescribing Ozempic for obesity (being indicated only for the treatment of type 2 diabetes) while awaiting the arrival of Wegovy in Spain - in the United States, Denmark, Norway, Germany, Switzerland and the United Kingdom can now be purchased.
This scenario has caused a lack of stock in pharmacies, where today it is a challenge to find a box of Ozempic, which complicates life for diabetics, who practically have no plan B. “One of the solutions is to try to look for it in another pharmacy or talk to your pharmacist so they can save it,” argues Antonio Pérez.
Sources from the Diabetis Association of Catalonia (ADC) assure that many of its members are on the waiting lists of pharmacies to obtain the drug, an extreme confirmed by LUDA Partners, the digital network of pharmacies that is dedicated to addressing the problem. shortage of medicines in Spain. This problem, according to the ADC, causes a lot of anxiety for diabetic patients as they do not know if they will be able to continue with the treatment.
Another option would be to change to a drug from the same family, “but there are also shortages,” Pérez recalls. There is - he adds - the oral alternative to Ozempic (Rybelsus, also from Novo Nordisk), although it is a newer medication. “There are more studies on the injectable (Ozempic). It is known that it not only affects diabetes and weight, but also reduces the risk of suffering cardiovascular events. With Rybelsus, this study does not exist yet.”
The shortage is such that the Spanish Agency for Medicines and Health Products (Aemps) issued a series of recommendations to alleviate supply problems. Among these, he recalled "the importance of sticking to the indication included in the technical sheet and prioritizing treatments to improve glycemic control in the treatment of adults with type 2 diabetes mellitus." Likewise, “and to the extent possible,” he asked not to start new treatments until the laboratories “confirm that they can supply the demand on a sustained basis.” In France they have gone further and have gone from recommendation to prohibition, suspending the start of new treatments.
“I don't think we have to find a culprit for the shortage,” reasons Dr. Núria Vilarrasa. “If it had been caused by another disease other than obesity, it would look different.” She recalls that there is “a very great need for effective treatments to combat this pathology,” which has become a “global pandemic.” In this sense, she explains that 22% of the Spanish population is obese and that if the same evolution continues, the percentage will grow to 37% in 2035.
And not only that: “There are three million deaths a year worldwide due to problems with excess weight, which is the basis of many other diseases, such as hypertension, diabetes, dyslipidemia, sleep apnea, liver disease, 13 types cancer, cardiovascular pathologies... People with obesity have a higher mortality and, therefore, we need treatments," he maintains.
For all this, he understands that there are patients with this pathology who are turning to drugs like Ozempic, indicated for patients with type 2 diabetes. “Until now they had nothing effective to inject; now yes. In the end, it is the same active ingredient, with a lower dose, of a drug that is very safe.” He hopes that with the increase in production the lack of supply can be remedied.
This is Novo Nordisk, which explains to this newspaper that in the next two years it will have invested more than 4.5 billion euros to expand the capacity of its “relevant production centers.” In addition, it claims to be investing almost 5.5 billion euros more in its plant facilities in Kalundborg (Denmark) and more than 2.1 billion euros in expanding the production plant in Chartres (France).
The boom in these drugs has made it the most valuable European company, with an estimated valuation of 421 billion euros, a figure higher than the GDP of Denmark, its country of origin. “In the last three years, its revenues have increased by 21.8% and its earnings per share have grown by 26.8%,” emphasizes Javier Cabrera, XTB analyst. “Likewise, its shares have appreciated by 48.9% in 2023, within a context that was very good for the financial markets,” he adds.
However, the company wants to continue increasing these good figures in light of what the forecasts predict. And the global market for anti-obesity drugs, according to Goldman Sachs estimates, could grow to 91.5 billion euros by 2030. Now, the business is worth 5.5 billion euros.
Novo Nordisk itself estimates that there are 764 million people with obesity in the world and that of these only 2% (about 15 million) are being treated. “Even assuming that this number did not vary and remained fixed, it is normal that, with the appearance of new drugs, the number of people accessing treatment will increase,” says Cabrera. “Hence,” he continues, “this company has a lot of room for growth, although it will not monopolize the entire market.”
Indeed, Novo Nordisk is not the only laboratory that aspires to have a relevant position when it comes to sharing the cake. Others like Eli Lilly also have products on the market, such as Zepbound (tirzepatide), which has been approved by the FDA (not yet by the EMA, although it has already recommended its authorization) and is identical, even in the dosages, to their drug - named Mounjaro - indicated for the treatment of type 2 diabetes. Many other pharmaceutical companies, such as AstraZeneca, Pfizer or Amgen, are accelerating the development of their own weight loss drugs.
