It’s hard not to talk about a “miracle” drug. At the Munchs, the arrival of innovative molecules has changed the life of the family. First of all, Christine, who took Ozempic two years ago to treat her diabetes. Her doctor had warned her: the weekly injection could also make her lose “a little” weight… Result, thirty kilos flew away. The quadra now weighs 73, and she continues to lose weight. His sister Martine, in her sixties, and her daughter Tracy, more than a hundred kilos each, were prescribed Saxenda last year and have already lost twenty. “The morale is coming back, we want to move again, to pay attention to ourselves”, smiles Martine, founder of the Stop Obesity association, in Colmar, and member of the National collective of associations against obesity (CNAO).
This new class of molecules mimics a hormone produced by the intestine, involved in the regulation of appetite and the feeling of satiety. First developed against diabetes, their indications are gradually being extended to obesity. “We feel fuller more quickly, we no longer snack constantly”, confirms Martine. And that’s just the beginning. After Ozempic (normally reserved for diabetics) and Saxenda, the NovoNordisk laboratory is preparing to offer an even more effective product, Wegovy. It contains the same molecule as Ozempic (semaglutide), but twice dosed. Available in the United States since 2021, it quickly made the buzz. On the TikTok network, women inject themselves in front of the camera, and in the celebrity press, the latest fashionable game is to guess which starlets use it… In France, the High Authority for Health has issued a favorable opinion on its reimbursement to the end of last year. The authorities and the laboratory are currently negotiating its price, the last step before its marketing. And other products should follow, such as Eli Lilly’s Mounjaro, which could benefit from an authorization this year across the Atlantic.
A revolution is thus announced for the care of obese patients, whose number continues to increase. According to one study presented this Monday, February 19 by the League against obesity and Inserm, they represent 17% of French adults, against 8.5% in 1997. Until now, the quest for molecules capable of helping them lose weight has come down to a long series of failures and scandals. Amphetamine derivatives (Pondéral or Isomeride), launched in the late 1980s by Servier, were withdrawn in 1997 because of their side effects – pulmonary hypertension and heart valve damage. In this family of molecules, only the infamous Mediator will remain marketed in France until 2009, as an antidiabetic but often misused for its appetite suppressant properties. There was also sibutramine, which could cause heart attacks and strokes. Or Acomplia (Sanofi), which large-scale trials have shown to increase the risk of depression and suicidal ideation…
“It will really have to be used wisely”
“This time, we see adverse effects as with any drug, but they are mainly digestive, with nausea, vomiting or diarrhea, rather moderate and often transient. At this stage, we have no signal in terms of cardiovascular safety”, says Professor Jean-Michel Oppert, head of the nutrition department of the Pitié Salpêtrière hospital (AP-HP), in Paris. Although Wegovy has already been offered for early access to 3,200 patients suffering from morbid obesity (the most serious stage of this pathology), specialists and patients are therefore impatiently awaiting its availability on a larger scale. “In the studies, the weight loss approaches that achieved by bariatric surgery (reduction of the size of the stomach, editor’s note). It is therefore a valuable tool, which we need for our patients, and it it will really have to be used wisely”, insists Professor Karine Clément, vice-president of the French Association for Studies and Research on Obesity. The great fear of this expert: that these molecules attract an audience that does not really need them. “The greater the number of patients treated, the greater the risk of seeing new adverse effects appear which could jeopardize the use of these molecules. This is why they must be reserved for those for whom they are the more useful”, pleads Karine Clément.
The risk of abuse is very real. In the United States, Canada or Australia, Ozempic has already been massively diverted by people wishing to lose weight. With the key to supply disruptions, which could put diabetic patients in difficulty. In France, the phenomenon would remain limited, despite the proliferation of influencer videos on social networks. According to our information, the rate of misuse assessed by Health Insurance does not exceed 0.6%, for 600,000 patients treated. “The manufacturer of Ozempic had alerted very early on, and there was a lot of work with doctors, so that they did not prescribe it wrongly and through”, explains Dr Jean-François Thébaut, vice- President of the French Federation of Diabetics.
Reserved for patients with severe or morbid obesity only
What will happen with Wegovy? Between the diktat of thinness and the enthusiasm of personalities like the billionaire Elon Musk – admittedly a little chubby before starting the injections, but not obese – the regulatory authorities are already in a cold sweat. Hence the recommendation of the High Health Authority to firmly supervise the prescription, reserving it for certain specialists, within the framework of care including a balanced diet, physical activity and psychological monitoring if necessary. . “This global support is the key to success”, confirms Professor Oppert. Furthermore, only patients suffering from severe or morbid obesity should have access to it, but not those suffering from moderate obesity. Nor a fortiori people who are simply overweight, for whom the drug does not have a marketing authorization anyway. “But how many will see the possibility of continuing to eat anything, anytime? If they are determined, they will go around the doctors until they get their prescriptions”, worries Anne-Sophie Joly, president of the CNAO.
For their part, laboratories like their investors see in these molecules future blockbusters. Especially since they are currently very expensive: 1,350 dollars per month for Wegovy and 975 dollars for Mounjaro in the United States. The analysis firm Iqvia is counting on a market of 17 to 48 billion dollars per year from 2027, or even 100 billion in the long term. Huge receipts which will however depend on the extent of the public concerned. “The target of overweight people is obviously much larger than that of obese people. The danger is that this population chooses the easy way out with these injections, and is even less encouraged to favor a healthy diet and to exercise. physical activity, which are essential for cardiovascular health, even beyond the question of weight”, worries Dr Jean-Pierre Thierry, medical advisor to France assos santé and co-author of Too much care makes you sick (Albin Michel). Not to mention that these molecules have only been evaluated in obese people, and not in the rest of the population…
Many other questions remain unanswered. The weight loss in the studies reaches 10% to 15%, but these are only averages: “These drugs do not always work, and we do not yet know how to distinguish upstream the patients in whom they will be effective” , says Professor Karine Clément. Scientists also lack perspective on the long-term risks, as rare cases of acute pancreatitis have been reported, as well as thyroid tumors in animal studies. Similarly, the optimal duration of treatment remains unknown. “Beyond two years, what is the strategy? Should we extend, stop, under what conditions? For the moment, we don’t know,” asks Dr. Olivier Foulatier, member of the scientific council of the Obesity League. As it is a chronic disease like hypertension or diabetes, most doctors expect long prescriptions, if not for life. In the United States, patients who have stopped Wegovy evoke a return of cravings and food compulsions, with a rapid recovery of the pounds lost. Even miracles have their limits.