Even before its arrival in France this month, Wegovy (pronounced Ouigovy), a new treatment for obesity, has attracted a lot of attention. For the spectacular weight losses that it causes but also, on an economic level, for its ability to transform the silhouette of its inventor, the Danish laboratory Novo Nordisk, which accumulates billions of dollars in sales thanks to this molecule, semaglutide. This GLP-1 (glucagon-like peptide 1) analogue represents a new class of products that affect appetite. “The molecule will attach to the stomach and slow down gastric emptying”explains Sébastien Czernichow, head of the nutrition department at the Georges Pompidou European Hospital.
Approved in Europe since January 2023, Wegovy arrives on the French market crowned with clinical results which show weight loss of between 15 to 17%, after a little over a year of treatment. Figures which have made the drug the target of diversion outside its original indication, particularly on the American market. In France, where nearly 10 million people are possibly affected by the treatment, the arrival of Wegovy promises to be particularly supervised to avoid such diversions.
Indications: who can benefit from them?
The drug has been granted marketing authorization in obese adults, that is to say with a BMI (body mass index) greater than 30kg per m2. It is also authorized in overweight people, with a BMI between 27 and 30, with at least one comorbidity factor (for example diabetes). The treatment is finally indicated in adolescents aged at least 12 years, weighing more than 60 kilos. Despite these indications, the use of this type of treatment could be more restricted in France.
In a desire to “secure their use in France”the ANSM, the medicines agency, communicated on a more limited recommendation than the original AMM, “we ask doctors (…) to prescribe GLP1 analogues to patients with an initial body mass index (BMI) greater than or equal to 35 kg/m2, aged under 65”communicated the agency this Tuesday morning based on the recommendations of the HAS (High Authority of Health).
The treatment will also be prescribed according to a well-marked circuit. The initiation of Wegovy will be reserved for doctors specializing in obesity, whether an endocrinologist, a diabetologist or a doctor specializing in nutrition. The renewal of prescriptions may however be ensured by the general practitioner. “We hope that this recommendation will evolve over time”however, underlines Etienne Tichit, general manager of Novo Nordisk France, who contrasts the volume of patients to be addressed with the insufficient number of specialists in France.
A medicine not reimbursed, for the moment
The treatment, at a dose of 2.4 mg, is done in the form of an injection made by the patient, under the skin and once a week. For the moment, it has not been reimbursed. The laboratory is free to set the price. Questioned this Tuesday morning, Etienne Tichit clarified: “Indicatively the treatment will cost around €9 to €12 per day”i.e. a cost of around 300 euros per month which raises questions about the percentage of patients who will really benefit from the treatment.
If Novo Nordisk refuses to communicate on its quantified objectives, the laboratory remains optimistic of a possible reimbursement. To do this, it intends to rely on the results of its clinical studies with several tens of thousands of patients monitored. “We were waiting to have the latest clinical results to be able to resubmit a reimbursement file. We hope to achieve this in 2025”Etienne Tichit projects. However, this treatment could only concern part of the population and be reserved for patients with severe obesity.
Availability: Novo Nordisk has increased production
In recent months, the Danish laboratory has experienced tensions over the supply of Wegovy. What is there to fear for the worst in the coming months? Novo Nordisk France wanted to be confident. “We made sure we could respond and that there were enough treatments so that patients could benefit from them in France. At this stage, we will not be in a situation, as we have experienced in the past, of having to block treatment initiations”reassured Etienne Tichit who insisted on production efforts.
Novo Nordisk, like its competitor Lilly, has invested massively in its industrial network. The laboratory, for example, injected more than two billion euros into its Chartres site, to double the production area. It has also invested several billion euros in Denmark to ensure the manufacturing of the active ingredient.
Far from being a miracle drug
“It is fundamental to change your lifestyle, if you do not change your behavior, you will not have a lasting effect”recalls Sébastien Czernichow, who insists on not qualifying the molecule, as well as other GLP-1 analogues, as “miracle drugs”.
“There cannot be a single answer to obesity”he emphasizes. For now, follow-up over one year has shown that patients maintained their weight loss… provided they did not stop treatment. “The causes of obesity are multiple, prevention remains imperative”recalls Isabelle Lonjon-Domanec, medical director of Novo Nordisk France.
Despite more difficult access conditions than in the United States, Wegovy should not remain alone on the French market for long. Another analogue of GLP-1, Lilly’s tirzepatide, received the green light from Europe last spring. And laboratories are working on other molecules, sometimes with even more spectacular results in weight loss.
Beyond obesity, these molecules are also used in other chronic diseases such as cardiovascular diseases, joint diseases, liver or kidney problems. “GLP-1 agonists allow us to go beyond treating diabetes and obesity, to look beyond weight loss”recalls Etienne Tichit. The arrival on the French market of Wegovy is undoubtedly only a first, symbolic step for GLP-1 analogues.
