3 Ozempic updates: Competition, warnings and potential uses

GLP-1 medications like Ozempic and Mounjaro might influence the volume of all-cause hospital admissions and bariatric surgeries, two studies suggest. 

Researchers at Boston-based Harvard Medical School and Brigham and Women's Hospital recently found a 132.6% increase in GLP-1 prescriptions and a 25.6% decline in bariatric surgeries between 2022 and 2023. The results add empirical evidence to a trend of declining operations that bariatric surgeons have been noticing for months. 

A Novo Nordisk trial also discovered an association between Wegovy prescriptions and fewer hospitalizations for any cause. In the study, 33.4% of patients taking Wegovy were admitted, compared to about 37% in the placebo cohort. Use of the weight loss drug was also linked to shorter hospital stays. 

Three other updates to know: 

Competition

Eli Lilly and Novo Nordisk are the main players in the GLP-1 field, but they're facing competition from compounding pharmacies, telehealth companies and even themselves. 

Since Eli Lilly's Mounjaro and Novo Nordisk's Wegovy and Ozempic fell into shortage in late 2022, compounding pharmacies have been manufacturing their respective generics, tirzepatide and semaglutide. Both drugmakers have filed several lawsuits against compounding pharmacies, medical spas, clinics and other drug companies for allegedly selling unsafe copycat versions; but despite these efforts, the market for generic GLP-1s has grown. 

In early November, telehealth company Hims & Hers said it would offer liraglutide — the generic for Novo Nordisk's weight loss drug Saxenda and diabetes drug Victoza — in early 2025. GoodRx is also now offering $149 30-day supplies of Qsymia, a non-GLP-1 weight loss medication. Similar moves by telehealth companies have attracted the attention of employers, who often cannot afford to cover brand-name GLP-1s. 

Other competition stems from newer weight loss drugs being tested at Eli Lilly and Novo Nordisk. Lilly has seen promising results from two obesity drug candidates, retatrutide and orforglipron; and Novo is betting on combining semaglutide with an experimental medicine, cagrilintide, with the expectation of 25% body weight reductions. 

Warnings

On Nov. 4 and 5, the FDA added a new warning to all approved GLP-1 medications. The drugs pose a risk of pulmonary aspiration during general anesthesia or deep sedation, according to rare postmarketing results reported to the agency. The FDA said there is not enough data to provide specific recommendations for mitigating this risk. 

A day after the warning landed on semaglutide labels, Novo Nordisk CEO Lars Fruergaard Jørgensen said he is alarmed by the amount of unsafe compounded GLP-1s in the U.S. market, adding that the copycats have been reportedly tied to 10 deaths. 

Potential uses

The FDA currently approves GLP-1 medications for Type 2 diabetes, chronic weight management and/or obesity-related cardiovascular events. 

Positive results from two Novo Nordisk studies hint at more indications, particularly for knee osteoarthritis-related pain and liver disease. After 68 weeks, Wegovy helped alleviate osteoarthritis pain by 41.7 points, compared to the placebo cohort's 27.5 points. 

The weight loss and cardiovascular medication also helped adults with metabolic dysfunction-associated steatohepatitis. In a 72-week study, 37% of participants receiving Wegovy saw improvement in liver fibrosis, compared to 22.5% in the placebo group. 

Novo Nordisk said it plans to seek an expanded Wegovy label in 2025.

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