Its logo needed nothing less than Apis, bull god of Egyptian mythology and symbol of fertility and strength, to embody the Danish laboratory Novo Nordisk, specialist in diabetes and manufacturer of the star drugs Ozempic and Wegovy. The latter has also obtained marketing authorization in France and has been available since Tuesday October 8 in France.
Fertility and strength, this is what the general director of Novo Nordisk, Lars Fruergaard Jorgensen, must feel, behind his very Scandinavian restraint. On March 7, the man whom the “Financial Times” named “personality of the year” announced, quite proudly, the results of the first phase of amycretin, this molecule which is taken orally to fight against obesity.
Twice as effective as previous treatments, the pill would allow a weight loss of 13% in three months. The next day, in duplex on an American TV channel, the boss of the Danish firm said: “It could be the best drug in its category. » Premature? No matter, the market is booming immediately. Novo shares reach 556 billion euros and climb to twelfth place among the most valuable companies in the world. In front of Tesla, whose boss, Elon Musk, also boasted on »
How did we get there?
Originally, in the mid-1990s, diabetes researchers made a surprising discovery about the Gila Monster. This venomous Arizona lizard is capable of going a long period without feeding. In its saliva, scientists isolate an element with a clever name, GLP-1, the intestinal hormone which regulates blood sugar levels. It will take them more than twenty years to synthesize it. This is the birth of a new generation of antidiabetics, GLP-1 agonists.
This is a colossal opportunity for patients to have additional treatment options
Two laboratories are then in the race: the Danish Novo Nordisk and the American Eli Lilly. Clinical trials show that blood sugar levels decrease, gastric emptying slows and acts on satiety. Result: the mice lose weight. When the dose is increased, the effect on body mass becomes even greater. No doubt, the researchers have something interesting there. This is because, previously, most of the molecules sold under the “weight loss” label were ineffective or had too many side effects. Miracle solutions came and went in step with failures and health scandals.
In France, Mediator, from Servier laboratories, has finished traumatizing the entire sector – this antidiabetic drug misused as an appetite suppressant is said to have caused the death of hundreds of people. “We can consider ourselves lucky that the laboratories have not lost interest in the French market,” explains Anne-Sophie Joly, founder of the National Collective of Obese Associations (CNAO). “It’s a colossal opportunity for patients to have an additional choice of treatment, in addition to bariatric surgery,” continues the woman who underwent a long course of operations, with a tear in the stomach then a painful reconstruction.
With Wegovy, we have seen very unexpected results, even in cases of genetic obesity.
“This therapeutic revolution is recent, we started prescribing Ozempic in 2019 for people suffering from diabetes,” specifies Dr. Muriel Coupaye, endocrinologist and diabetologist at the Louis-Mourier obesity center, in Colombes (92) .
The protocol?
Patients inject the product every week using a periwinkle blue injector pen. After Ozempic, an overdose formula quickly follows, Wegovy, which targets obese patients, and its result reaches up to 15% weight loss. An outcome as satisfactory as surgery, but without going through the knife. Quickly marketed in the United States, where it costs $1,349 per month, per patient – for life – Wegovy was only authorized on Tuesday in France. Previously, it was in early access. That is to say on a test sample of 10,000 patients, with strict criteria: people with a body mass index (BMI) greater than 40, and at least one comorbidity factor linked to weight.
“We prescribed it to everyone eligible under early access and we saw completely unexpected results. Never seen before, even in certain cases of genetic obesity,” specifies Dr. Muriel Coupaye. This first restricted phase completed, Novo will still have to convince and change its image – too cosmetic and not scientific enough – to obtain the widest possible reimbursement in France. In order to better defend itself before the Transparency Commission of the High Authority for Health, Novo financed its own study which would show that Wegovy also has cardiovascular benefits. “The file will be submitted soon,” writes us the communication from the Danish firm.
A counterattack
At the same time, Eli Lilly, the rival laboratory from Indianapolis, is preparing its anti-obesity weapon: Mounjaro, based on tirzepatide, a combination of an analogue of GLP-1 and another digestive molecule, GIP. Nicknamed the “King Kong” of weight loss drugs by the “Wall Street Journal”, it could cause you to lose up to 22.5% of your body weight! It smells like a blockbuster. The American manufacturer has obtained its European marketing authorization and should arrive in France in 2025. It is an understatement to say that Dr. Muriel Coupaye is impatiently waiting for it, and she is not the only one.
More than a billion people worldwide are obese
To meet this demand, and flood the market, Eli Lilly invested 2.3 billion euros in a new site in the Rhineland. Novo, which deplores numerous stock shortages of Ozempic, has announced 2.1 billion euros of investment in its site in Chartres. The news even earned, in November, a visit from Emmanuel Macron in a blouse and cap between the production lines of injector pens. Lured by the promises of profits, all the pharmaceutical giants want to be part of it. Pfizer is in the testing phase, and AstraZeneca says it has signed a license to regain the rights to an oral treatment. “More than a billion people in the world are obese: 650 million adults, 340 million adolescents and 39 million children,” confirms the WHO*. Obesity appears poised to become the next blockbuster pharmaceutical category.
The economic impact will exceed $4 trillion by 2035
Associated with numerous comorbidities and higher mortality, this pathology is becoming a major public health and financial issue. “The economic impact will exceed $4,000 billion by 2035,” announces Jérôme Berton, pharmacist and manager of the Cité Gestion-Tech Care fund in Switzerland. “It’s a pandemic that doesn’t speak its name. We rarely have the case of a market whose limits extend significantly. A year ago, brokers were talking about a market of 30 billion dollars, and now it is estimated at 150 billion dollars! » To hear him say, anti-obesity is a must-have in a stock market portfolio, comparable to the best-sellers in oncology.
“The medicine causes the disease,” recognizes Professor Martine Laville, author of a report** submitted last year to the Ministry of Health, which proposed forty recommendations. She hopes for a road map or, even better, a ten-year obesity plan like the cancer plan, with a real project on the “obesogenic environment”. But ministers change with the seasons… and Professor Laville waits. Although obesity is a chronic disease recognized by the WHO since 1997, awareness of the emergency is slower. “Politicians find it difficult to talk about it because it affects the body, it’s still a taboo subject! » she explains.
There are psychological causes, all these things will not be cured by an appetite suppressant
“These treatments make it seem like it’s always a big deal to be fat. And then obesity is not only an excess of food, there are psychological causes, a link with abuse and trauma… All these things will not be cured by an appetite suppressant. As with all diets, at first, people will be happy to lose, but that doesn’t solve anything. The solution would be to accept that people are a little bigger than average to prevent them from becoming even bigger by being rejected,” worries Sylvie Benkemoun, psychotherapist and president of the Reflection Group on obesity and overweight (FAT).
Dr. Muriel Coupaye answers him. “The medication does not work alone, it requires support, as with bariatric surgery. The drug is one more tool. » If, for the moment, the only known – and very common – side effects are gastrointestinal disorders, patients are not all reassured. “I’m careful, we’ve heard of miracles. I took thyroid extracts and amphetamines, and all of them were withdrawn from the market,” recalls Sylvie Benkemoun.
Finding the right formula for each patient
Faced with the collective enthusiasm, Professor Laville warns: “Specialists in endocrinologists, diabetologists and nutritionists must be able to prescribe and continue academic research to compare these drug offerings, individualize treatments to find the right formula for each patient. » She also fears that the misuse of the treatments will lead to its share of accidents and that they will be withdrawn from the market.
A sign that Eli Lilly and Novo do not lack appetite, the latter lists ten new generations of drugs in research and development against obesity, while the American is preparing its retatrutide, already nicknamed “Godzilla”.
* Publication dated March 4, 2022. ** “Better prevention and management of obesity”, report of April 24, 2023.
