Ireland on the cusp of obesity treatment revolution but high cost of drugs causing disquiet – The Irish Times

Ireland is at the forefront of a revolution in treating obesity, but whether the state can afford it has raised concerns for health services.

The new weight loss treatment has been hailed as a miracle drug, but its first side effect is a huge cost headache for HSEs and has raised concerns among doctors and patients about fair access.

New drugs, heavily touted by celebrities and influencers, are creating tremendous demand around the world, leading to concerns about affordability and equity of access. ‘s products are rapidly becoming popular all over the world and there is a huge shortage of products.

Ireland lags behind other countries in making these treatments available, but HSE announced in January last year the reimbursement of Saxenda, the first new-generation drug for the treatment of obesity. It has started. Demand has soared he by 42%, with more money expected to be spent on anti-obesity treatments in just one year than the five-year budget.

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The next drug, Wegovy, is more effective in trials and is expected to see even greater demand as it requires weekly injections versus Saxenda’s daily injections. A lower dose version known as Ozempic is available here, but it is officially only used to treat diabetes.

Other products in development are said to be even more effective in helping people lose weight.

They changed our clinical approach to the problem because they are the first truly effective drugs against obesity.

— Francis Finucane, endocrinologist, professor of medicine

New drugs bring new hope to people who have struggled with excess weight for years when many other options have failed. The result can be a significant improvement in quality of life,” says Susie Barney, director of the Obesity Patients Coalition in Ireland.

Francis Finucane, an endocrinologist at Galway University Hospital and professor of medicine at the University of Galway, said:

“They are the first truly effective drug against obesity and have become available at a time when access to bariatric surgery, the only other really safe and effective option, is very limited, so the problem has been solved.” It has changed our clinical approach to patients, especially for the general public, in Ireland.”

side effects

There are side effects, but the most common are nausea and vomiting. And there is evidence that people who stop taking them regain the weight they lost and then regain some.

“Regardless of how good these drugs are, the question is whether patients have access to them,” says Finucane. “In our obesity clinic, patients wait up to two years for evaluation, and 70% of patients have a medical card, but their obesity drugs are state-funded. there are very few.”

Barney is concerned about the “blurring of the lines” between those who need these treatments and those who simply need them. “Obesity drugs are for the chronic disease of obesity, for people who need treatment. That should be a priority.”

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Despair for weight loss in obese people is often driven by the stigma they perceive, she says. I want to do whatever it takes to lose weight, and the problem is that a lot of people want to use these drugs on thinner bodies.”

The eventful history of previous anti-obesity drugs and the active role of pharmaceutical companies in promoting profitable new treatment options gives ample grounds for fear. It must be taken for life, and its long-term effects are currently unknown.

There is no doubt that these drugs lead to weight loss. It has not been shown to reduce the adverse effects of excess weight, such as cardiovascular problems.

— Professor Michael Barry, Clinical Director, National Center for Pharmacoeconomics

The job of Professor Michael Barry, clinical director of the National Center for Pharmacoeconomics, is to monitor the cost-effectiveness of new drugs.

“These drugs are different. They are moderately well tolerated by patients and are very effective,” he says. , has not been shown to reduce the adverse effects of excess weight.

Drug treatments for obesity have been around for decades, but there have been many false dawns. Another was associated with increased blood pressure and a third was associated with an increased risk of suicide and had to be removed from the market.

lizard poison

A new generation weight loss drug is based on a substance first identified in a rare lizard found in the US desert and found to affect blood sugar levels. The substance had a short lifespan, but scientists modified it for use in humans so that patients could produce more insulin as needed.

The first use of this synthetic hormone, known as a GLP-1 (glucagon-like peptide-1) receptor agonist, was to treat diabetes, but when scientists realized it led to weight loss in test mice, new research began. The frontier of has opened.In 2021, semaglutidewas marketed as Wegovy based on lizard venom and received US approval.

With such a huge potential market, where more than 60% of adults are overweight or obese, Barry’s concern is cost. “This pharmaceutical group already sees a significant annual spend of €55 million, and this amount will increase dramatically once Wegovy becomes available.

“We will see a significant increase in the number of 30,000 patients already taking these drugs and an associated increase in costs. will be.”

Negotiating with pharmaceutical companies can keep costs down, but at the cost of delayed patient access. Saxenda was originally priced at €3,500 per patient per year, but Barry said the final agreed price was “significantly lower.”

Another way to keep costs down is to limit access to drugs. To qualify for Saxenda, patients must have a body mass index of 35 or higher, be pre-diabetic, and have evidence of cardiovascular disease, such as high cholesterol or high blood pressure.

Half of the 2,600 applications for the drug since January have been rejected for these reasons, Barry says. Similar access control programs may be introduced for other anti-obesity drugs.

Only “a handful” of Finucane’s patients meet the eligibility criteria. As a result, most people self-fund their needs.

“Highly hereditary”

Barney says he understands government concerns about cost control, but points out that many obese people have tried every other option. But you can’t maintain that weight loss because your body’s genetic makeup is different.People don’t understand that.”

“There is a psychological component, and it can be highly heritable. 40-70% of obesity is hereditary.”

I went to the gym for 3 hours every morning, 5 days a week, and walked 8 kilometers 5 days a week.

— Susie Barney, director of the Obesity Patients Coalition in Ireland

She says she’s lost a lot of weight five times in her life, and each time the weight “came back and more.”

“I’m 11 stones after bariatric surgery. I’ve never really reached a normal BMI. [body mass index]So I always felt like a failure. Even if you walk for an hour every day, you won’t lose weight. I went to the gym for three hours every morning, five days a week, and walked eight kilometers five days a week. I started to

Armed with positive trial results, the pharmaceutical companies behind the new treatments have been working hard to promote them. was suspended by the UK Pharmaceutical Industry Association for marketing violations related to Saxenda.

The company has paid out £21.7m over three years to UK medical institutions and professionals as part of its influence campaign.

Another Irish subsidiary paid €345,000 in consulting and registration fees to medical professionals and organizations.

[ Business: Slimming drug Wegovy triggers significant forecast upgrade at Novo Nordisk ]

Many of the voices talking in the media about new obesity treatments and organizations are being paid by the company, which they explain as supporting medical education.

same ingredients

Barry says he has nothing wrong with drug companies selling their own products, but “is concerned about people publicly extolling the virtues of drugs”.

But for these drugs, he believes “they do what it says on the tin.”

In Ireland, Saxenda is available for obesity and Ozempic for diabetes, but Wegovy is not yet available. Ozempic and Wegovy are the same ingredients in different doses. Physicians can prescribe approved drugs “off label” for various indications.

Finucane says his clinic tends to prescribe Ozempic. In his view, Ozempic is “probably better” than Saxenda, and a crucial reason is about €130 per month compared to Saxenda’s €250 per month.

Novo Nordisk wrote to Irish doctors last year asking for guidance on “proper prescribing”, noting that Saxenda, not Ozempic, is licensed to treat obesity. “Given that Wegovy, a more potent dose of Ozempic, is in fact licensed for obesity in Europe, the clinic’s decision not to make Ozempic available for the treatment of obesity in Irish patients is clinically unacceptable. It can feel commercial rather than commoditized,” said Finucane. Say.

“Global stock shortages and supply issues are also impacting the availability of Ozempic to Irish patients. One is his daily struggle with serious health problems, and the other is his cultural desire to be thin.

“I couldn’t stand to see my patients’ health worsen when they ran out of Ozempic, which was prescribed in their place in beauty clinics.”

A spokesperson for Novo Nordisk said that Ozempic, Wegovy and Saxenda are “all different products with different indications, dosages and titrations.”

Ozempic is “approved by the European Medicines Agency for the treatment of type 2 diabetes only and can therefore only be marketed pursuant to this authorization”. We are licensed.

In Europe, a spokesperson said: “Wegovy has been launched in Denmark and Norway and is expected to be launched in many other countries in 2023. When EMA is launched, all pharmaceutical companies will be able to market their products across the EU markets where their products are available. We need to ensure equitable supply, not in favor of more countries with bigger markets.Novo Nordisk faces the same supply challenges that affect the broader pharmaceutical sector and broader economic activity. facing.”