Is Semaglutide a Band-Aid, or a Solution?

The Spectacular Rise Of Semaglutide

Seemingly out of nowhere, semaglutide has become the blockbuster drug of the decade. It was first developed by Novo Nordisk (NVO ) in 2012 and mimics a weight-related hormone called GLP-1 (glucagon-like peptide-1).

From its initial use as a diabetes drug, it was recently approved and repackaged under the brand Wegovy for a new application: weight loss. The commercial relaunch of Wegovy in January 2023 has been nothing short of spectacular, with sales exploding in a line straight up and only hindered by supply constraints.

It actually caught Novo Nordisk by surprise, with the company ramping up production regularly and still seeing recurring shortages from a constantly growing demand.

Source: Novo Nordisk

Wegovy’s success made Novo Nordisk’s valuation skyrocket, going above the entire GDP of its home country of Denmark.

The Wegovy / GLP-1 drugs’ effects go beyond diabetes or obesity. It is now shown to reduce heart disease risks, through a yet-to-be-elucidated mechanism that is different than just the weight loss. It has even been linked to a dramatic decline in heart failure and other cardiovascular disease-related deaths.

Semaglutide was linked to a 28% reduction in major adverse cardiac events, as well as a 24% reduction in cardiovascular disease-related deaths for this subgroup of people with preexisting heart failure, and a 19% reduction in deaths of any cause.

Decline In Other Obesity Treatment

The consequences of this instant success are still hard to understand fully. In a study by researchers at the Harvard Medical School, Brown School of Public Health, and Brigham and Women’s Hospital, published under the title “Metabolic Bariatric Surgery in the Era of GLP-1 Receptor Agonists for Obesity Management”, it was found that while the use of GLP-1 drugs to treat obesity more than doubled from 2022 to 2023, the rates of obesity-related surgery (bariatric surgeries) dropped by one quarter.

This clearly indicates that people are picking drugs over more invasive surgeries like gastric sleeve and bypass.

Source: GI Society

This was done using older data, where “only” 5.0% of patients received GLP-1 RAs and 0.3% received surgery. So, it is likely that 2024 data will see a much higher number receiving GLP-1.

This sparks some concerns from doctors that surgery might decline in popularity, despite being the most efficient treatment against obesity.

“With the national decline in utilization of metabolic bariatric surgery and potential closure of bariatric surgery programs, there is a concern that access to comprehensive multidisciplinary treatment of obesity involving pharmacologic, endoscopic, or surgical interventions may become more limited.”

Thomas C. Tsai, MD, MPH – Metabolic bariatric surgeon in the Department of Surgery at Brigham and Women’s Hospital.

It also illustrates the large market yet to be captured by GLP-1 drugs. In the future, this could include other drugs, like Amycretin, also researched by Wegovy producer, Novo Nordisk, which targets both GLP-1 and amylin, a pancreas hormone controlling hunger.

Is Semaglutide Really Harmless?

Any new wonder drug like semaglutide has to be pretty powerful, especially when it affects the entirety of the body’s metabolism. This naturally raises some alarm bells for doctors, wary of yet-unknown side effects.

In fact, an array of rare but serious side effects has already been identified and are listed on Wegovy’s dedicated web page, including thyroid cancer, pancreas inflammation, kidney failure, depression or thoughts of suicide, and gallstones.