In the first six months of 2023, Denmark’s GDP rose by 1.7% from 2022, but without the contribution of one company, it would have fallen by 0.3%. That company is Novo Nordisk, a pharmaceutical corporation and now the most valuable company in Europe with a market value higher than the entire rest of the Danish economy. The reason behind its recent success is a single drug: semaglutide, sold under the brand names Ozempic and Wegovy. So what exactly is it and why is it so popular?
Semaglutide belongs to a group of medicines called Glucagon-like peptide-1 agonists or GLP-1 RAs. They work by mimicking the GLP-1 hormone, which is an incretin (a hormone involved in diet and appetite). One role of GLP-1 is to prompt the body to produce more insulin, which reduces blood sugar. It also inhibits the secretion of a hormone called glucagon. Since glucagon stimulates glucose (sugar) production, inhibiting its release lowers blood sugar levels. Hyperglycaemia or high blood sugar is present in all type 2 diabetics. For that reason, semaglutide has been used in the UK since 2006 to treat type 2 diabetes (diabetes caused by insulin resistance). Novo Nordisk has sold semaglutide for the purpose of lowering blood sugar levels under the brand name Ozempic since 2017 (and since 2019 in the UK).
Following a clinical trial in 2018 and several additional studies it has been proved that semaglutide (when used in conjunction with dietary changes and exercise) can cause significant weight loss in people who are obese or overweight. In the original trial, after 68 weeks half of the participants using semaglutide combined with a healthy diet and exercise lost 15% of their body weight, and nearly a third lost 20%. In comparison, participants who incorporated only lifestyle changes lost about 2.4% of their body weight.
This is because in higher amounts GLP-1 - which interacts with nerve cells both in the gut and in the brain - also interacts with the parts of the brain that suppress appetite and make you feel full. It slows the movement of food through the stomach and intestines, reducing the speed of digestion and therefore causing you to feel fuller. This can eventually lead to weight loss as people lower their food intake.
While other GLP-1 RAs such as liraglutide have previously been approved for use as an anti-diabetic and anti-obesity medication, semaglutide works significantly better than any previous drug at reducing blood sugar levels and food intake. This is a hugely significant advance for people suffering from diabetes or people experiencing complications arising from being overweight, and particularly for those who struggle to lose weight just from altering their diet and exercise regime.
Novo Nordisk decided to sell semaglutide for weight loss under the brand name Wegovy, and this was approved for use in the UK in 2021 but only launched in September 2023. While Ozempic and Wegovy both contain exactly the same drug - semaglutide - one difference between the two is the recommended dosage. Ozempic is approved for a maximum dose of 1.0mg whereas up to a 2.4mg dose of Wegovy can be given. The other important difference is that Ozempic is licensed only for managing blood sugar levels in people with type 2 diabetes and unlike Wegovy, is not approved for managing weight loss. Despite this, Ozempic can still be prescribed by healthcare professionals as ‘off-label’. This means that it is being prescribed for use in a different way than that stated in its licence. The medicine will still have undergone clinical trials to ensure its safety and efficacy, however, it is being prescribed to treat a different condition or a different demographic than the one used in the trial.
Why is this relevant? Well, semaglutide has experienced a recent explosion in popularity and most of this comes from off-label prescriptions of Ozempic. The rise in demand has principally been fuelled by social media, which is full of posts and hashtags about the drug. On X (formerly known as Twitter), Elon Musk confirmed that he uses Wegovy, while other celebrities such as Khloé Kardashian have felt the need to issue denials that they don’t. Influencers have posted videos about their experiences using Ozempic for weight loss. These video posts often fail to mention potential side effects associated with its use, for example, nausea, vomiting, and more serious effects including pancreatic inflammation.
The other issue with all this exposure is that there have been Ozempic shortages for people with type 2 diabetes who rely on Ozempic to manage their condition, partly caused by the increase in off-label prescriptions. The Department of Health and Social Care (DHSC) has advised that the supply of GLP1-RAs is not expected to return to normal until at least mid-2024. In a letter to healthcare professionals Novo Nordisk stated that Ozempic should be prescribed for type 2 diabetics to manage blood sugar levels and that ‘any other use [of Ozempic] including for weight management [...] currently places the availability of Ozempic for the indicated population at risk [...]'. During this shortage period, as per DHSC recommendation no new patients should be initiated on Ozempic.
While the current supply issues are a serious problem, semaglutide should still be seen as an amazing breakthrough in treating people suffering from diabetes and obesity. Rishi Sunak has certainly seen the potential effects this could have in Britain, with a new £40 million pilot announced this year (2023) citing Wegovy as a key treatment the NHS will use. Ministers are hoping it will help to cut waiting lists by reducing the number of people who suffer from weight-related illnesses, who often require more support from the NHS and sometimes end up needing operations linked to their weight such as gallstone removal or hip and knee replacements. Only time will tell if the drug can live up to these expectations, but either way, the economic power of the pharmaceutical industry, demonstrated by Novo Nordisk, cannot be denied.