An employee at Novo Nordisk's facility in Hillerod, Denmark on Feb. 12. About 40 million people around the globe receive Novo Nordisk diabetes and weight-loss medications.CHARLOTTE DE LA FUENTE/The New York Times News Service
The long-awaited arrival in Canada of an effective medication to treat obesity marks an important moment for some people living with the disease, but experts say persistent barriers to access need to be tackled.
Earlier this month, drug maker Novo Nordisk announced that Wegovy, the brand-name version of the drug semaglutide, approved for the treatment of obesity, is now available in Canada after a major delay owing to worldwide demand. The company also sells semaglutide under the brand name Ozempic, which comes in a different dose and was approved in Canada to treat Type 2 diabetes. It has been available here since 2018.
Semaglutide is a glucagon-like peptide 1 receptor agonist, or GLP-1. It’s a class of drugs that mimic the body’s own GLP-1 hormone, found in the gut, which plays a critical role in controlling insulin and glucagon levels.
Demand for Ozempic since its release in Canada and around the world has been unprecedented, fuelled by stories from people who easily lost weight while taking the medication. Although it’s officially approved as a diabetes drug, doctors have the discretion to prescribe it in an off-label capacity to people who don’t have diabetes.
As a result, prescriptions for Ozempic soared, leading countries such as Canada to experience shortages. And this prompted heated debate over who should have access to the highly effective medication. Demand has yet to dissipate, with spending on semaglutide on the rise, and more evidence has emerged that the drugs can also reduce the risk of heart attacks and other serious health problems, such as liver disease and chronic kidney disease.
Now that the obesity-treatment version of the drug is available, experts say they hope it helps reduce the long-standing stigma faced by many people with the disease and changes the perception that carrying excess weight is solely a personal choice. But in order to help those living with the disease, issues such as who pays for the drug need to be addressed.
For instance, earlier this year, Ontario limited coverage for Ozempic under its drug benefit program to individuals with a diabetes diagnosis. A federal pharmacare program that would provide universal access to diabetes medications would exclude Ozempic.
“I think it’s unconscionable it’s not covered,” said Samir Gupta, a clinician scientist at the University of Toronto who focuses on knowledge translation and science communication. “Obesity, if we think of it as a chronic disease, it justifies the coverage.”
GLP-1 drugs were the biggest contributors to increased spending by public drug plans in 2021, according to the Canadian Institute for Health Information. Spending rose by $130-million that year.
In 2022, CADTH, a federal body that provides advice on drug coverage and is now known as Canada’s Drug Agency, recommended that the provinces and territories not cover the cost of Wegovy. According to its report, the decision was based on the fact that it wasn’t clear that taking the drug provided any health benefits beyond helping people shed pounds.
However, experts such as Daniel Drucker, one of the researchers who discovered the GLP-1 hormone decades ago, believes that is about to change. Clinical trials of semaglutide and similar compounds such as tirzepatide, sold under the brand name Mounjaro, are showing promise beyond weight management.
A study published last fall in the New England Journal of Medicine found that in a group of non-diabetic people taking semaglutide, 6.5 per cent experienced a heart attack or other serious cardiovascular event, compared with 8 per cent in a placebo group.
Other trials are in advanced stages of determining if semaglutide and similar agents are effective at treating a range of conditions, including Parkinson’s disease, sleep apnea, liver disease and more, Dr. Drucker said.
“We don’t know the results of all of those trials,” said Dr. Drucker, a clinician-scientist based at the Lunenfeld-Tanenbaum Research Institute at Mount Sinai Hospital in Toronto. “It’s quite likely that at least some of these Phase 3 trials will be positive and will be able to expand the benefit of these medicines. It’s a very exciting time.”
As for side effects, Dr. Drucker noted that GLP-1 drugs have been in use for nearly two decades, while Ozempic itself has been on the market for several years. Bob Dent, the founder of the Weight Management Clinic at the Ottawa Hospital, said there are side effects with semaglutide – nausea, vomiting, bloating, constipation, stomach pain – but there are a “ton more” with obesity.
That’s not to say GLP-1 or similar drugs are right for everyone or a quick fix. Some people can carry extra weight and be healthy, Dr. Dent said. If people do decide to take medication, they should know that they’ll need to be on it for a long time and will need to take other steps, such as undertaking an exercise program, he said.
“It’s a matter of risk versus benefit. When it works, it works really well, but it doesn’t work in everybody.”