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Fat Profits or a Fat Lip for pharma?

By Terry Maguire - 06th Mar 2023

Terry Maguire looks at the effects of a new weight loss drug and how it compares with its predecessors

Annual continuing professional development (CPD) is a requirement for most professions, including pharmacy.  Keeping up-to-date with our art and craft is essential to keeping our customers and patients safe. There is considerable freedom for individual pharmacists to choose what subjects they wish to complete in the required annual hours of CPD, and drug manufacturers have always been a useful and convenient source of lectures and seminars.

The Sunday Times in February (2023) reported a row that had broken out over questionable weight loss seminars. The Association of the British Pharmaceutical Industry (APBI), which oversees pharmaceutical companies in the UK, instigated an investigation against one of its members, Novo Nordisk, which allegedly used weight-management seminars for pharmacists to promote and market its medicine Saxenda. 

Interestingly, last summer a locally-based investment manager asked my views on Novo Nordisk, the Danish-based company. He had spotted an interest in the company among key investors due to the launch of Saxenda, its anti-obesity medicine. Other drugs in this class are indicated for the treatment of diabetes, but Saxenda has an indication for weight loss, which makes it potentially a blockbuster drug. With this licensed indication, there is always a challenge to how the drug would be marketed.

My reply to the investment manager was positive. Novo Nordisk is a great company, with its origins in the discovery of insulin. August Krogh, a Danish academic and Nobel Laureate, visited the US for a lecture tour in 1922, and when there met Banting, Best and MacLeod, who had just discovered insulin and its role in diabetes. From them, Krogh secured permission to manufacture, back in Denmark, the new life-saving hormone.  This is the basis of Novo Nordisk, which was set up on a foundation structure so that profits could be used for the benefits of mankind with an emphasis on improving public health through research and development. 

Modern understanding of the complex cascade of hormones, and feedback systems, that regulate metabolism generally and the metabolism of glucose specifically has allowed companies, particularly Novo Nordisk, to develop more targeted drugs to improve diabetes management. Obesity is of course the main risk factor for type 2 diabetes that represents 90 per cent of all diabetes and sadly, it is rising year-on-year as our population gets fatter.  

Obesity and its consequences, diabetes, are a major public health challenge and the leading cause of amputation, blindness and kidney disease, as well as a major contributor to heart disease and reduced life expectancy. Obesity and deaths from Covid were very strongly correlated during the pandemic. It’s also a huge cost for healthcare systems and will bankrupt the UK NHS if not managed. Sadly, our public health efforts to reduce the incidence of obesity by dietary restriction and increased activity have been largely ineffective. The processed and fast-food industries and our dependence on labour-saving devices have conspired to create an obesogenic environment that few of us seem strong enough to counter.  Fintan Moore had an interesting comment on this in his column a few months back. So if we cannot employ a lifestyle strategy, then the logic is that the answer is in a medicine, and you can see the logical extension that Saxenda might just be that solution.

This drug, and other GLP-1 agonists (Victoza, Ozempic, etc), stimulate insulin secretion and slow down the release of glucose, therefore improving diabetes control. GLP-1 agents also help weight loss by reducing appetite and increasing satiety. They can reduce weight by about 4.7kg in six months. Good, but not that good, and all weight returns when the drug is stopped.

Big Pharma has always been keen to exploit the lucrative obesity market, but medicine regulators have been more cautious. Weight loss drugs generally have not had a good track-record and were mostly associated with serious side-effects. The chemical dinitrophenol, for example, is a very effective weight loss agent but if you use it, there is a high chance you will die.  Likewise, amphetamines. Acomplia, a cannabis-blocking drug launched in the early 2000s, was based on the observation that cannabis smokers get the ‘munchies’. It is an effective weight loss agent but side-effects include suicide, so it was withdrawn.

So if we cannot employ a lifestyle strategy, then the logic is that the answer is in a medicine

Medicine regulators are very strict with a medicine that is submitted for an exclusively weight loss licence.  The regulators require studies to demonstrate body weight loss of at least 10 per cent in six months, and that’s a big ask. Most companies don’t bother and those that have patented GLP-1 agents opt for a diabetes licence with the added advantage of weight loss of a few pounds, which can only be good. Saxenda is therefore an exception. 

The GLP-1 agonists are not without side-effects, the most common being nausea, vomiting and low blood glucose. More serious, less common side-effects include effects on the pancreas and gallbladder and rarely, suicidal thoughts. Check them out at https://www.saxenda.com/about-saxenda/side-effects.html.

When Saxenda got its exclusive weight loss licence, the market changed. There has been an explosion in private clinics providing the drug on a commercial basis at about £300 a month. This is also getting celebrity attention, which is increasing usage and causing shortages of the drug. 

Hopefully the APBI censure might give the company a fat lip and force it to rethink its business strategy for Saxenda. But the profits it is now enjoying from the supply of this drug and which allowed my investment friend to realise 34 per cent increase in share value for his clients since June 2022 will, I believe, only encourage more to enter this area.

On researching this article, I came across a bizarre news item from the US. ‘Ozempic Face’ is now a recognised medical concern. Ozempic is widely used for weight loss and it is so effective that people, due to weight-loss, develop a wrinkly face. It’s the old adage, ‘there’s no wrinkles on a balloon’. Well, you can see the logic of the need to developing a medical treatment for ‘Ozempic Face’.

Perhaps that might be my next CPD course.

Terry Maguire owns two pharmacies in Belfast. He is an honorary senior lecturer at the School of Pharmacy, Queen’s University Belfast. His research interests include the contribution of community pharmacy to improving public health.

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