Semaglutide, has become a blockbuster drug like no other, making its manufacturer Novo Nordisk the most valuable listed company in Europe. Sold under brand names Ozempic or Wegovy, it’s held up as some kind of weight loss miracle cure, but demand is so high, that it’s been hard to supply the patients with type 2 diabetes for whom it was first indicated.
Semaglutide is an analog of glucagon-like peptide 1 which has direct, glucose-dependent effects on insulin secretion. In this episode we first talk about how semaglutide compares to other drugs in its class as a treatment for diabetes. The greatest challenge to its hold on the market may come from the soon-to-be launched tirzepatide, which is a dual agonist for the glucose-dependent insulinotropic polypeptide receptor as well as GLP-1.
These incretin pathways also regulate gastric motility and central pathways related to appetite. It’s this combination of effects that causes weight loss of 15 to 20 percent in trials on patients with obesity or other weight-related comorbidities. Nevertheless, the Pharmaceutical Benefits Advisory Committee has held off granting these drugs a listing given their high cost.
This hasn’t stopped social media influencers and the wider public, getting access to the drug off label, and paying hundreds of dollars for it. We discuss the challenges for clinicians and regulators created by such hype, and also the concerns associated with indefinite consumption of these medications.
Guests
Professor Chris Rayner MBBS PhD FRACP (Gwendolyn Michell Professor, Adelaide Medical School; Consultant Gastroenterologist, Royal Adelaide Hospital)
Professor Gary Wittert MBBch, MD, FRACP (Mortlock Professor, Adelaide Medical School; Senior Consultant Endocrinologist, Royal Adelaide Hospital)
Professor Rayner has previously received funding from Eli Lilly and Sanofi for investigator-initiated studies to understand the mechanisms of action of exenatide and lixisenatide respectively. He’s also on an advisory board for Glyscend Therapeutics which is developing a muco-adherent polymer to mimic the effects of bariatric surgery. Professor Wittert has received supplementary funding from Bayer in 2012, for an NH&MRC-funded and investigator-initiated study.
Production
Produced by Mic Cavazzini DPhil. Music courtesy of Free Music Archive includes ‘Mister S’ by Tortue Super Sonic. Music licenced from Epidemic Sound includes ‘Multicolor’ and ‘Flower Fountain’ by Chill Cole, ‘Blacklight’ by John B Lund, and ‘Habitual’ by Ava Low. Image by Ketut Subiyanto courtesy of Pexels.
Editorial feedback kindly provided by RACP physicians Stephen Bacchi, Aidan Tan, David Arroyo, Joseph Lee, Jia-Wen Chong, Li-Zsa Tan, Fionnuala Fagan, Stella Sarlos and Marion Leighton.
Please visit the Pomegranate Health web page for a transcript and supporting references. Login to MyCPD to record listening and reading as a prefilled learning activity. Subscribe to new episode email alerts or search for ‘Pomegranate Health’ in Apple Podcasts, Spotify, Castbox or any podcasting app.
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