semaglutide is available on prescription but not reimbursed

Semaglutide (Wegovy 2.4 mg, Novo Nordisk), – probably the drug that has attracted the most attention recently due to its convincing effects in terms of weight loss – is now available in France for the treatment of overweight and obesity ^[1].

Indicated in 3 categories of patients: adults with obesity (BMI ≥30 kg/m²), those who are overweight (BMI ≥27 kg/m² at

In order to benefit from it, patients will need to present a medical prescription. Given the risk of misuse, theNational Medicines Safety Agency (ANSM) has issued recommendations concerning GLP-1 analogues indicated in the treatment of obesity, in this case Wegovy, the initial prescription of which must be carried out by a specialist, while renewals can be ensured by doctors general practitioners (see box below)^[2].

Obesity and overweight + CV risk factor

After having been the subject of early post-MA access, semaglutide (the same as Ozempic in diabetes but at a different dosage) is now accessible to the greatest number of people – subject to being able to finance the purchase – because in In the absence of reimbursement (see box at the end of the article), the daily treatment cost could be of the order of 9 euros to 12 euros, comparable to other countries on the European continent where the drug is available, specifies the laboratory.

To date, the AMM stipulates that Wegovy^® (semaglutide 2.4 mg) is indicated as an adjunct to a hypocaloric diet and increased physical activity for weight control, including weight loss and weight maintenance, in adults with obesity (BMI ≥ 30 kg/m²) or overweight (BMI ≥27 kg/m² at

Note that it is also indicated in adolescents from 12 years of age with obesity (BMI ≥ the 95th percentile for age and sex) and a body weight greater than 60 kg.

One in 3 patients achieved >20% weight loss in the semaglutide 2.4 mg arm
Professor Sébastien Czernichow

94% sequence homology with human GLP-1

How does semaglutide work on weight loss? Due to its analogy with GLP-1 (glucagon-like peptide 1) – the molecule has 94% sequence homology with its human version – semaglutide selectively binds and activates GLP-1 receptors, targets of GLP. -1 native (notably present in several regions of the brain involved in the regulation of appetite as well as in the heart, the vascular system, the immune system and the kidneys).

Thus, semaglutide reduces energy intake, the feeling of hunger and the frequency and intensity of cravings; it increases the feeling of satiety, satiation and control of food intake. All of these effects lead to weight loss, mainly through the loss of fat mass. “The half-life of the molecule is approximately 1 week, hence the weekly injections,” explained the Pr Sébastien Czernichowhead of the nutrition department at the Georges-Pompidou-APHP European Hospital (Paris) during a press conference ^[1].

Note that semaglutide reduced the inflammatory marker high-sensitivity C-reactive protein (CRP) in the original study. SELECT which suggests other mechanisms and possibly other effects – such as those observed on the cardiovascular level – with this drug.

As a recent study shows, the results obtained in real life may be less good
Professor Sébastien Czernichow

Average weight loss of 15% to 17%

Obtaining marketing authorization for Wegovy® (semaglutide 2.4 mg) is based on program data STEP (Semaglutide Treatment Effect in People with Obesity), i.e. 18 phase III clinical trials evaluating semaglutide 2.4 mg administered subcutaneously once a week in people who are overweight or obese, for a total of 8,700 patients. The founding STEP 1 trial notably showed an average weight loss of 15% to 17% maintained over 68 weeks (i.e. one year and 4 months), in addition to a low-calorie diet and increased physical activity, in adults and adolescents. “Some patients – but it is not possible to determine in advance which ones – are even super responders,” said the nutrition specialist. One in 3 patients achieved weight loss > 20% in the semaglutide 2.4 mg arm.”

However, the results may not always be as impressive, he moderates. “As a recent study shows, the results obtained in real life may be less good. Which is not surprising because unlike clinical trials, patients are not supported in terms of nutrition and physical activity.”

The opportunity for Professor Czernichow to emphasize the importance of lifestyle modifications (via diet and physical activity) which complement drug treatment.

Another pitfall: regaining weight when treatment is stopped, which would require maintaining the medication over the long term, like what is done for other chronic illnesses, points out the nutritionist.

Finally, semaglutide is not devoid of adverse effects, a little more numerous than in the placebo group, knowing that the most frequent are of a digestive nature (nausea, diarrhea, vomiting, constipation, abdominal pain) – “but the more often transient, and of mild to moderate intensity and leading to discontinuation of treatment in less than 5% of cases.

To manage this inconvenience, the practitioner advises on the one hand, “to inform patients of their possible occurrence” and, on the other hand, “to stop at the best tolerated dose” knowing that the initiation of semaglutide is done in dose increments ranging from 0.25 mg to 2.4 mg, the recommended maintenance dose, over approximately 17 weeks, with an increase every 4 weeks.

This suggests that weight loss alone could not explain the CV benefit and therefore that there is also a specific action of semaglutide.
Pr François Schiele

A marked cardiovascular effect

If semaglutide also has an indication in overweight patients (BMI of ≥27 kg/m² at SELECT. During its presentation at a congress, the trial had also attracted the population of cardiologists, as evidenced by the enthusiasm of Dr. John Mandrola that we relayed on the site last year. As a reminder, out of 17,604 adults (including 160 in France) with a BMI ≥27 kg/m²semaglutide 2.4 mg resulted in a statistically significant 20% reduction in the relative risk of major cardiovascular events (MACE), with risk reductions consistently demonstrated across age, gender, race and ethnicity. the starting BMI in people who are overweight or obese and have established cardiovascular disease without diabetes.

This enthusiasm is shared by the Pr François Schielecardiologist at Besançon University Hospital, who observes that the effect of Wegovy (semaglutide 2.4 mg) on ​​the risk of MACE – the divergence of the curves – appears from the start of treatment, “a fairly remarkable effect” notes- it, especially since “the study satisfied almost all secondary criteria, including all-cause mortality, reduced by 19%”. “This suggests that weight loss alone could not explain the CV benefit and therefore that there is also a specific action of semaglutide. It’s been a long time since we’ve seen that,” he summarized.

The community of cardiologists made no mistake and included semaglutide in the 2024 recommendations of the European Society of Cardiology (ESC) on stable coronary syndromes, in all diabetic patients, regardless of HbA1c level ( recce 1A). She also suggests considering prescribing semaglutide in patients who are not diabetic (type 2) but are overweight (BMI > 27 kg/m²) or obese to reduce the risk of CV mortality, myocardial infarction and stroke (reco 2A).