The ‘miracle’ drug to treat diabetes, which is also used against obesity and has become known worldwide for the latter reason under the trade name Ozempic, has a competitor. On July 1, Mounjaro begins to be marketed in Spain, a medication from a new therapeutic group – tirzepatide – that promises “a significant enhancement of the effect”, both in weight loss and in the control of markers that measure diabetes. with a “more complete mechanism of action,” according to the company that brings it to the market, Lilly, and which will present the drug in Madrid this Monday.
The pharmaceutical company, which already sells the compound in the United Kingdom, Germany, Poland and the United States, has seen surprising results in its trials. Half of diabetic people (type 2) achieved normoglycemia – a normal blood sugar level, comparable to someone without the disease – and four out of ten with obesity reduced their weight by 25% or more, a proportion equivalent to that It is achieved with surgery and allows you to begin to reverse associated complications.
The novelty of Mounjaro is that it blocks two hormones that are produced in the intestine when we eat: they are the GLP1 peptide (on which Ozempic acts) and, more novelly, GIP. Both are part of a complex system that regulates, in addition to insulin in the blood, appetite. “It increases the feeling of satiety and insulin secretion, slows gastric emptying and increases the metabolism of adipose (fat) tissue,” says the medical director of Lilly in Spain, José Antonio Sacristán.
This double effect explains the great success of these drugs in several ways. In therapeutics, health professionals have embraced these molecules because they are an effective resource to treat two diseases that affect “more than 30% of the Spanish population,” explains Inka Miñambres, member of the obesity area of the Spanish Society of Endocrinology and Nutrition (SEEN). “All international directives lead us to the fact that drugs against diabetes, in addition to controlling it, generate cardiovascular and renal benefits,” adds Carlos Miranda, head of the Diabetes Working Group of the Spanish Society of General and Family Physicians (SEMG). . The two believe that Mounjaro’s arrival is “another resource” and “good news.”
Ozempic is only funded for the treatment of diabetes; If this criterion is not met, the doctor can prescribe it as a way to lose weight but it is paid out of the patient’s pocket. It costs about 140 euros per month. Mounjaro will not be covered for anyone because the pharmaceutical company has expressly requested the exclusion from the Ministry of Health “to be in the pharmacies as soon as possible,” confirms a company spokesperson, who attributes this decision to an administrative matter. “There was a lack of recognition of the value of tirzepatide in diabetes and it was included in the GLP1-ar group without recognizing the new therapeutic class it represents,” she develops.
The second angle that makes up the ‘puzzle’ of success is the social one. Become a best-seller, it has become popular among those who want to lose a few kilos in the heat of influencers and celebrities – like Elon Musk or Kim Kardashian – who tout its benefits even to the point of causing supply problems. To obtain the prescription in Spain, the patient must have a Body Mass Index greater than 30. Below, it should not be indicated even if the patient pays for it. “There are people who are looking for it through alternative means, without medical follow-up or controls, just for the fact that they lose weight,” confirms Miranda, who remembers that to be effective it must be combined with a healthy diet and physical exercise. There is consensus among the sources consulted that prioritization should be given to the most at-risk people when prescribing it and never do it “outside the technical specifications”.
Two months ago, the Spanish Agency for Medicines and Health Products (AEMPS) warned that Ozempic was being prescribed “for indications not included in its technical sheet” and recalled that it is a priority for diabetic people for whom it is funded, to avoid shortage. He even detected that it was being sold without a prescription in some pharmacies. The problem is on a global scale: the World Health Organization’s surveillance system has recorded, as a result of the growth in demand from 2022, an increase in counterfeit medicines from this family – those containing semaglutide – throughout the world.
High expectations
If the sector thought it had seen everything with boom of coronavirus vaccines, this phenomenon seems to have arrived to displace that one. The Danish pharmaceutical company that manufactures Ozempic, Novo Nordisk, launched another product called Wegovy with the same molecule but higher doses, specifically indicated for the treatment of obesity. This drug began to be sold in Spain on May 1 and is not funded.
Last September, Novo Nordisk became the European company with the highest stock market value. Then it was worth 398,000 million euros. In 2023 the company shattered its results: it recorded a profit 50% higher than a year before. 11,225 million euros. The income linked to the marketing of Ozempic (almost 13,000 million) and Wegovy are responsible for this growth.
Lilly has high expectations for Mounjaro: since 2020, the company has spent $18 billion on four new factories specifically for this drug (two in the United States, one in Ireland and one in Germany), explains medical director José Antonio Sacristán. to elDiario.es. “In anticipation of demand we have prepared ourselves, we do not want to market the drug until we have some security of supply. We have tripled production capacity,” he notes.
These types of drugs also guarantee lifelong consumption. Once you stop taking it, your appetite returns and, with it, the kilos that were lost. Clinical studies show that people who stopped taking Wegovy They regained two-thirds of their weight. “There is not much difference regarding hypertension; When they stop taking it, it goes up,” Miñambres illustrates. This chronicity has turned these compounds into the goose that lays the golden eggs.
Lilly does not want, at the moment, to reveal the cost of the drug, although it anticipates that it will be “competitive” in relation to the others already on the market. Ozempic or Wegovy have a price of about 140 euros per month and professionals suspect that Mounjaro will move around similar figures. One of the questions that arises with the arrival on the market of the first competitor for Novo Nordisk is whether it will end up lowering prices.
And for obesity?
“The big problem with these drugs is that they do not have public funding for the obesity indication. None of them,” highlights Alfredo Michán, coordinator of the Diabetes, Obesity and Nutrition Group of the Spanish Society of Internal Medicine (SEMI) and one of the doctors who will participate in the event organized by Lilly for the presentation of the new Mounjaro.
Among some endocrine professionals and nutritionists, especially, it is frowned upon that authorities refuse to fund these compounds as a resource for the treatment of obesity. “The discussion that is now taking place is why the National Health System funds one indication and not another. Society still has a blaming approach to obesity: you are like this because you don’t take care of yourself. And it is not a choice of the patient, who has neither guilt nor responsibility,” claims Miñambres, who recalls that obesity can have very important consequences for health such as heart attacks, strokes and increased risk of diabetes, among other diseases.
“We must keep in mind that money is finite, but there are already clinical trials with semaglutide that say it reduces morbidity and mortality in people who have suffered cardiovascular events,” Michán clarifies. And then he adds: “They are drugs that represent a significant health expense given the prevalence of obesity that we have in our country and I understand that it must be considered calmly. For effectiveness there is no doubt, but also for efficiency.”
In fact, Ozempic is not emerging as the first prescription option for diabetes even though it is funded. “It is a prescription that we call third line, other drugs such as metformin are prioritized,” says Dr. Miñambres. Carlos Miranda agrees that older medications are still used. “It is true that it has a very high cost and must be very controlled, but the system finances drugs that are also very expensive for other diseases. When patients can benefit, there is no need to put obstacles in place to avoid spending,” she says.