Novo Nordisk has brought its weight-loss drug Wegovy to India while Eli Lilly has got the regulatory nod for its Mounjaro pens. However, these “blockbuster” drugs may not be the answer to India’s obesity and diabetes endemics as they need to be supplemented with lifestyle changes, says Anvitii Rai
l How Mounjaro, Ozempic and Wegovy differ
MOUNJARO, WEGOVY AND Ozempic belong to a class of therapies known as Glucagon-Like Peptide-1 (GLP-1) receptor agonists (RAs). They differ based on their ingredients, strength, and approvals. Wegovy is a semaglutide weekly injection available in dosages of 0.25 mg, 0.5 mg, 1 mg, 1.7 mg, and 2.4 mg, and is approved by the US Food and Drug Administration (FDA) for treating obesity in adults with a body mass index (BMI) of 30 or higher (obese) or a BMI of 27 or higher (overweight) with a weight-related condition like high blood pressure.
Ozempic is a Wegovy variant with a lower dosage (0.5 mg and 1mg), approved specifically for treating type-2 diabetes. Meanwhile, Mounjaro has tirzepatide as its main ingredient, grouped under GLP-1 RAs as well as glucose-dependent insulinotropic polypeptide (GIP) RAs (GIP is a hormone similar to GLP-1). It is approved for treatment of type-2 diabetes, while its obesity treatment variant is known as Zepbound. Mounjaro and Zepbound can be administered at higher dosages (starting at 2.5 mg, going up to 15 mg). All are prescription drugs.
l How do these drugs help lose weight?
GLP -1 IS A hormone released when food is eaten to slow gastric emptying (the process through which food leaves the stomach), so that the body can absorb nutrients from food. It also increases insulin release from the pancreas (helping combat high blood sugar) and controls the feeling of satiety. Drugs like Wegovy artificially activate the GLP-1 receptors in the brain, decreasing the feeling of hunger, causing one to eat less. It is mainly used for those with type-2 diabetes as it helps keep blood sugar in check and helps with insulin resistance, which is what most of such patients encounter. With healthy lifestyle changes such as taking a better diet and exercise, these drugs can help manage type-2 diabetes and obesity as well as help patients with other concerns such as cardiovascular issues and polycystic ovarian syndrome (PCOS).
l Many side effects
COMMON SIDE EFFECTS of GLP-1 RAs include nausea, vomiting, diarrhoea, belly pain and constipation. Tirzepatides also cause reduced appetite and indigestion. As these drugs are relatively new, not much is known about long-term effects. However, a study by the UK’s Medicines and Healthcare Regulatory Agency (MHRA) and Genomics England said many users of these drugs reported pancreatic problems. The MHRA also warned women using these to use effective birth control pills if they are utilising them, as the former may make the latter less likely to work in those who are overweight or obese. Also, these medications must be used for the long term, as a 2022 trial from the Diabetes, Obesity and Metabolism journal suggested that people who stopped using semaglutide at Wegovy’s 2.4 mg doses regained two-thirds of their lost weight within a year.
l Can it help India’s obese population?
AS PER A Lancet study, India’s obesity rate is among the world’s top three, with 70% of its population being overweight or obese. More than 100 million Indians are diabetic and 136 million are pre-diabetic. GLP-1 RAs thus can be a shot in the arm to control this endemic. Patients using these drugs have reported a weight loss equivalent to 15-20% of their bodyweight, surpassing surgical interventions. A 2023 clinical trial by Novo Nordisk on more than 17,000 adults aged 45 years and above, who were overweight or obese and had cardiovascular diseases but no history of diabetes, indicated that it significantly reduced their risk of major heart problems like heart attacks for up to five years. However, it must be noted that the long-term effects of these drugs are currently not known, so such drugs, at present, must be used as prescribed by healthcare providers.
l Availability and affordability
DESPITE GLOBAL DEMAND, Ozempic is not available in India. The other two will be avaiable in drug stores in the coming months. Wegovy will be priced at Rs 17,345 ($202) for its monthly 0.25 mg, 0.5 mg and 1 mg doses (with four doses being needed in a month). The 1.7 mg dose will cost Rs 24,280 ($284), and the 2.4 mg version will cost Rs 26,015 ($304) for a month’s supply. Mounjaro, on the other hand, costs Rs 3,500 ($41) for a 2.5 mg vial and Rs 4,375 ($51) for a 5 mg vial, its lowest doses. However, a Yale University study has shown that these medications cost $22 (`1,880) to manufacture, making the profit margins for manufacturers huge (Novo Nordisk posted a $15 billion profit last year).
Notably, semaglutides are coming off of the patent next year, and Indian pharmaceutical giants such as Sun Pharma, Dr. Reddy’s, Cipla, etc., are reportedly accelerating their efforts to manufacture the generic variants, which will be much cheaper. Reuters quoted an analyst stating that the prices of these drugs “can correct 60% to 90%” once generics enter the market. Novo Nordisk had launched Saxenda (liraglutide, another GLP-1 RA) in 2023, but higher costs and limited availability has restricted adoption.