Obesity researchers are hailing 2023 as a landmark year, with the dramatic rise of a new class of weight loss medications that could revolutionize treatment. Semaglutide drugs like Wegovy and Ozempic, deemed this year’s “Breakthrough of the Year” by Science magazine, are demonstrating unprecedented results helping patients achieve significant and sustained weight reduction.
Millions Stand to Benefit from Novel Mechanism of Action
Unlike previous generations of weight loss pills, semaglutide works by mimicking the appetite-reducing hormone GLP-1. In multiple clinical trials and real world usage this year, semaglutide drugs have shown 15-25% body weight reduction on average, far exceeding older drugs. Importantly, the weight loss has proven durable over 2-3 years for many patients. With over 40% of American adults considered obese, semaglutide could potentially help millions.
Dr. Mikhail Kosiborod, a cardiologist at the University of Missouri, tweeted about semaglutide, “Truly a breakthrough year for obesity Rx!” He added, “GLP-1 drugs tackle obesity in a physiologic way no other therapy has done before. Huge implications for public health if access expands.”
Currently, semaglutide is FDA approved for chronic weight management and broadly covered by public and private insurers. However, the recent demand surge is creating shortages.
Viral Momentum for Off-Label Uses Drives Shortages
While excitement builds among obesity specialists, semaglutide gained viral popularity this year thanks to enthusiasm for off-label use. Ozempic saw demand spike as word spread on social media about dramatic weight loss achieved when prescribed for diabetes at lower doses.
As Cardiologist Dr. Florian Ederer tweeted, “Ozempic’s life-altering weight loss at diabetic doses made patients do anything to get it. Clinics overwhelmed by requests despite little data to back it.”
Prescriptions for Ozempic, Wegovy and other semaglutide drugs jumped 1100% in 2022 compared to 2021 according to pharmacy benefit manager CVS Caremark. This demand contributed to pervasive shortages of all brand name GLP-1 drugs by December.
Medical Community Split on Off-Label Prescribing
Experts are divided on the prudence of prescribing semaglutide medications off-label specifically for weight loss. Proponents argue that obesity is a disease and these drugs now offer the most effective path to remission. Hence, providers should prescribe them similarly aggressively as they would for diabetes or high cholesterol.
Critics however counter that more safety data is needed before widely deploying this novel class of medications off-label. The pace of prescription also threatens shortchanging supply for on-label uses like diabetes where semaglutide confers survival benefits.
This central question of ethical off-label prescribing promises to be a flashpoint debate among obesity specialists in 2024 committee meetings and medical journals.
Looking Ahead: Generics, New Data and Provider Access
Despite the short term shortage frustrations, the advent of semaglutide heralds great progress to curb the obesity epidemic in the years ahead.
Generics
Patents will expire paving way for lower cost generics. Novo Nordisk’s Ozempic patent expires in 2023, opening doors for generic semaglutide in 2024. This could exponentially expand access.
Real World Data
2022 saw smaller trials show 15-25% weight loss over 1-2 years on semaglutide. 2023 will bring far larger datasets from real world usage to better clarify safety, efficacy and variability in longer term results. This data could inform future refined prescribing protocols.
Provider Access
If compelling open label data accumulates, obesity medicine specialists predict primary care providers are more likely to prescribe in 2024. This could allow substantially more patients to access medications. Currently only 3% of primary care providers are prescribing semaglutide drugs off-label.
While the breakthrough capabilities of GLP-1 drugs are now established, their ultimate impact depends on how future policies, prescribing culture and supply chain realities evolve. 2023 set the stage with a glimpse of the immense promise and complexity ahead.
Table 1: Currently Available GLP-1 Agonist Medications
| Drug Name | Brand Name | Year Approved | Primary Indication |
|---|---|---|---|
| Semaglutide | Ozempic, Wegovy | 2017, 2021 | Type 2 Diabetes, Chronic Weight Management |
| Tirzepatide | Mounjaro | 2022 | Type 2 Diabetes |
|Liraglutide|Victoza|2010|Type 2 Diabetes
|Dulaglutide|Trulicity|2014|Type 2 Diabetes
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