OW2020: High Expectations for Semaglutide in Obesity

Expectation, painting by Gustav KlimtSaxenda (liraglutide) is on the brink of becoming a billion dollar drug for obesity. Yet its effectiveness in obesity is modest. On average, a person taking it might expect that their weight would go down by about eight percent. Of course, some people will have a much bigger benefit. But others will have less or none. By contrast, bariatric surgery patients might expect a 25 percent reduction in their weight. So the expectations are high for a new drug in obesity, semaglutide. At ObesityWeek 2020, Tom Wadden reported effectiveness for this investigational drug. The results represent roughly twice the effectiveness of Saxenda.

On average, the weight of people taking semaglutide was 16 percent lower at the end of this 68-week study. Slightly more than a third of patients (36 percent) lost 20 percent or more of their weight.

Better Effectiveness

Without a doubt, this is better effectiveness than current anti-obesity medicines deliver. It’s a big step toward the goal of having anti-obesity medicines that work as well as bariatric surgery. So the folks who devote their work to providing obesity care have high expectations for semaglutide.

All of this has Novo Nordisk very optimistic for the future of its obesity care business. Chief Science Officer Mads Krogsgaard Thomsen sees the potential for a doubling in sales before 2025.

“We never said double – we said more than double. But now we’ve got better data from the Step programme [of semaglutide] and the combo than we predicted, so we might achieve that target earlier than we thought.”

Much Work to Do

However, a bit of caution would be wise. Even with a billion dollars in sales, the utilization of Saxenda is very low. This is an expensive drug and because of that, the overwhelming majority (>80 percent) of prescriptions for obesity are for cheap generics – like phentermine.

On top of that, only about two percent of patients with obesity even receive a prescription for any anti-obesity medicine. Primary care providers remain skeptical about the net benefit of drugs. Yes, they can help with maintaining a lower weight and reduce risk factors like blood pressure, lipids, and blood glucose. But we don’t have definitive data on major health outcomes – survival, heart attacks, and strokes, for example.

For that, we have our eyes on the cardiovascular outcomes study with semaglutide – the SELECT study. This study began in 2018 and will not be complete until 2023. However, if the results are positive, we expect it to mark a turning point for obesity care.

So yes, we have high expectations for semaglutide. Delivering twice the effectiveness of current anti-obesity medicines is hardly trivial. But we also have much to learn about the health outcomes it delivers.

Click here for the abstract of the semaglutide study presented at ObesityWeek. For further perspective, click here and here.

Expectation, painting by Gustav Klimt / WikiArt

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November 10, 2020