For some years now, the so-called anti-obesity drug, a product that alone is causing sales to soar profits of pharmaceutical companies, always so indebted and squeezed between patent deadlines on the one hand and research costs on the other.
Born as a drug to treat diabetes, and while it remains one of the most innovative and effective drugs for diabetic pathology, its scope of treatment has expanded to include the problem of obesity, which affects over a billion people worldwide, according to the World Health Organization. But what is this drug and how does it work? How much does it cost and for how long can it be taken? But above all, in what other areas can it act?? Great prospects are opening up for pharmaceutical companies.
Attilio Speciani, clinical immunologist in Milan and professor of nutritional immunology at the University of Pavia, who has been studying for many years even serious diseases resulting from excess sugar in the body, believes that the discovery of the new molecule is a good news for science because it lifts another veil on the direct relationship between sugars in the blood e serious illness: from Alzheimer's, to kidney failure to heart disease. In this interview he explains all the characteristics of the new drug and indicates possible future developments.
Dr. Speciani, it is surprising how this anti-obesity drug has shaken up the pharmaceutical industry: a golden goose for the companies that produce it. Starting with the Danish pharmaceutical company Novo Nordisk which, thanks to these drugs, has become the most capitalized company in Europe (about 530 billion euros) and alone contributes to half of the growth of Denmark's GDP (1,8% expected in 2024). From a medical point of view, how do you see this drug? How does it work?
The first products of this type appeared around 2005, but their use began between 2019 and 2020. The Danish company Novo Nordisk gave the commercial name of Ozempic to its semaglutide: a molecule that was created to fight diabetes and that still has a notable efficacy for diabetes: its mechanism of action in fact involves on the one hand an increase in the production of insulin (the hormone that lowers the level of sugar in the blood), on the other it keeps blood sugar levels under control, imitating the action of a substance that every organism produces naturally in healthy conditions.
But then it was seen that this same drug also had other potential. It is a molecule that acts as a GLP-1 receptor agonist, which in other words means that it also has the ability to reduce appetite by sending satiety signals to the brain and is able to modulate many other metabolic signals. Hence the weight loss in a few months of treatment.
The market for weight-loss drugs has exploded, especially due to strong demand from the United States. Goldman Sachs estimates that it could reach 130 billion dollars by 2030: a golden goose for pharmaceutical companies. At the moment it seems that the race is two-horse race. In addition to Novo Nordisk, Eli Lilly is also gaining ground. But other pharmaceutical companies are coming forward: from the Swiss La Roche, to the German Boehringer Ingelheim, to the US Pfizer and Viking Therapeutics. On what grounds are they measuring themselves?
Obviously, all of them are competing in the field of research. At the moment, there are two problems that these pharmaceutical companies are concerned about and that they want to solve soon. On the one hand, obtaining authorization from the competent authorities to use these drugs not only for the treatment of diabetes, but also of obesity: this would open the way to greater insurance coverage and consequently to greater diffusion. On the other hand, there is the problem of the price: at the moment it is still very high and, in fact, if there is no insurance coverage, few can afford it. One of the challenges is precisely that of finding a less expensive solution.
How is the drug treated in Italy?
In Italy, as in France and Switzerland, this drug is recognized to treat diabetes and only in this case is it covered by the national service.
However, even without insurance coverage, the molecule is spreading. Novo Nordisk has created a drug similar to Ozempic, but specifically to fight obesity, Wegovy, which received authorization from the Food and Drug Administration in the United States in 2021 and from the European Union in early 2022. If you take that drug to fight obesity, how long can you use it?
The period of taking it obviously depends on the patient and the extent of the overweight. I would say up to about 18 months.
What happens when you stop taking it?
This is one of the important points. Those who want to fight obesity and want to do it only with this drug, once they stop taking it, find themselves with a significant "rebound" effect, technically called the rebound effect and in the vast majority of cases they regain all the lost pounds and even more. A bit like what once happened with products that inhibit appetite such as amphetamines, which however acted at a neurological level, and which in fact never solved the problem of overweight and obesity except for temporary periods and with serious associated risks.
The element that my research group (GEK Lab) and I have appreciated favorably is that this type of drug acts on the effects of glycation, a topic that we have been studying in an innovative way for many years. Glycation is caused by the individual excess intake of sugars and similar substances (glucose and fructose - therefore also fruit - alcohol, artificial sweeteners and excess carbohydrates) and can be controlled by measuring specific glycating substances. By measuring these markers, personalized nutritional suggestions can be set that lower these values, teaching each person the diet that best suits their individual characteristics.
How should we proceed then to ensure that the effect of these new drugs lasts over time?
Taking the drug alone is not enough. It must be accompanied by a personalized dietary practice and a suitable lifestyle: it must be managed with well-known methods and techniques that we also adopt in our center, so that the reduction of glycation obtained with the diet is accompanied by the reduction of glycation favored by the drug and that at the time of suspension one does not find oneself experiencing the "rebound" effect for having only reduced the quantity of food for a while. If the action of a diet that controls glycation is integrated with the drug, lasting results can be obtained over time.
This drug was a big surprise. In fact, in 2023 it won the “Breakthrough of the Year” award from Science, one of the most famous scientific journals in the world, opening new avenues. So could this molecule, or a similar one, also be used to treat other diseases besides diabetes and obesity?
From a scientific point of view, this case is very interesting because it opens the door to many areas of research. In particular, those related to the effects of glycation on the body and all the diseases that derive from it: just to name a few, Alzheimer's, cognitive decline, major cardiovascular problems such as acute myocardial infarction and stroke, fatty liver, renal failure and some types of cancer (in addition to overweight and diabetes, of course). This drug has lifted another veil on the problem of sugars that we have been working on for years.
