Lights and shadows of new anti-obesity drugs

#Lights #shadows #antiobesity #drugs

Many media advertise it as Hollywood’s fashionable drug or the miracle against obesity, while others focus on the problems of shortages due to inappropriate use. Ozempic and other drugs with similar action to treat obesity have been crowned as the scientific breakthrough of 2023 by the magazine Science. Are the wonders that are told about them true?

First of all, let’s make it clear that Ozempic is the commercial name that the Danish pharmaceutical company Novo Nordisk has given to its goose that lays the golden eggs: semaglutide, an active ingredient that is also marketed as Rybelsus y Wegoby. The latter is approved throughout Europe, but at the moment it is only dispensed in Denmark, Sweden, Germany and the United Kingdom. It is expected to arrive in Spain at the end of 2024 or beginning of 2025.

A global plague

The commotion has its reason. According to the World Health Organization, the global prevalence of Obesity almost tripled between 1975 and 2016with the consequent increase in associated diseases such as type 2 diabetes, coronary heart disease and certain types of cancer.

Our society and our health system need to develop weapons and strategies to combat it. And although the preferred line continues to be prevention with healthy habits – physical activity and diet –, the search for pharmacological treatments is booming.

Drug arsenal

Currently we have three types of anti-obesity medications, with their corresponding mechanisms of action. Some reduce the absorption of calories from the diet, others focus on the central nervous system and, finally, there are those that act from different fronts at the same time, such as reducing appetite, improving glycemic control or increasing sensation. of satiety.

Compounds belonging to the latter category were originally designed as antidiabetics. We are talking about sodium-glucose cotransporter inhibitors (glyphocins) and, above all, incretin analogues or incretinomimetics, the most effective for treating obesity to date.

The revolution against obesity?

Also known as glucagon-like peptide-1 (GLP-1) receptor agonists, incretinomiméticos They are injectable medications, although some are already administered orally. They increase insulin secretion, inhibit the release of glucagon (which promotes glycemic control) and suppress appetite. This results in glucose-dependent insulin release and a reduction in blood glucose levels after meals.

The first drug in this group, exenatide (Byetta), was marketed in Spain in 2006 and since then eight more active ingredients have followed. Some of the most popular They are liraglutide (Victoza), dulaglutide (Trulicity) or the aforementioned semaglutide (Ozempic, Rybelsus and Wegoby).

If they have been on the market for almost 20 years, why is there so much talk about them now? The reason is the recent discovery of its effectiveness in combating obesity. It was observed that, in addition to the positive effects on glycemic control, patients undergoing treatment for type II diabetes mellitus considerably reduced their weight with these appetite suppressant medications.

The true revolution of semaglutide lies in the fact that it was the first active ingredient to receive approval to treat obesity, despite the fact that both liraglutide as la exenatida They were already used unofficially for that purpose.

Added advantages

Beyond weight loss and glycemic control, research appears every day that reveals new benefits of these drugs, such as reducing blood pressure, a cardiac risk factor.

The results They also suggest that protect the liver, kidney and against age-related cognitive decline, including Alzheimer’s disease. Or that the satiating action (anticraving) of semaglutide could be applied in the treatment of alcoholisma possibility that has generated debate among experts.

Harder to find than a needle in a haystack

As Bernard Shaw said, there is nothing more dangerous than being too popular. This applies to the current situation with semaglutide. The expectation raised by the media, social networks and word of mouth has skyrocketed the popularity of this drug to such an extent that its manufacturer is having trouble meeting current demand.

The Spanish Medicines Agency, for example, has admitted that the use of Ozempic in private weight loss clinics has exacerbated the lack of supply.

The shortage began with the promotion of its slimming properties by celebrities like Kim Kardashian. This viral advertising has forced patients who need it to treat their diabetes to wander from pharmacy to pharmacy in the hope of finding it. Fake Ozempic injections are the order of the day.

It is not a harmless drug

At this point, it is important to note that semaglutide is not a panacea against obesity, and that its administration is not safe. Like any medication, may cause side effects such as nausea, vomiting and diarrhea.

Although acute pancreatitis and pancreatic cancer have also been reported, The available data does not support that increases the risk of suffering from these diseases. However, from July 2023 The European Medicines Agency (EMA) is reviewing the safety of Ozempic due to its relationship with suicidal thoughts.

Aside from serious adverse reactions, its possible aesthetic effects must also be taken into account. Thus, after losing weight quickly with semaglutide, some people experience notable changes in your face: loss of facial volume, increased sagging and a haggard appearance. It is the so-called “Ozempic face”, and some patients even consider undergoing aesthetic medicine treatments to correct it.

What happens when we stop taking semaglutide?

Every beginning has its end. In the case of Ozempic, it arrives when the patient has reached their goal weight or cannot tolerate the nausea that the medication produces. Is the weight maintained afterwards or is there a “yo-yo effect”? In this regard, a study published in 2022 revealed that after a year the patients regained two thirds of the kilos lost.

These data make it clear that semaglutide is not the miracle against obesity that it is sometimes advertised as. However, it can be a therapeutic ally to improve the effectiveness of nutrition and lifestyle modifications, which are the cornerstone of treatment against excess weight.