Questions and answers: Weight loss medication "Wegovy" can be prescribed in Germany from Monday

No more yo-yo effect and kilo frustration? An appetite suppressant drug holds the promise of weight loss and weight control for obese and some overweight people.

Questions and answers: Weight loss medication "Wegovy" can be prescribed in Germany from Monday

No more yo-yo effect and kilo frustration? An appetite suppressant drug holds the promise of weight loss and weight control for obese and some overweight people. Doctors in Germany can prescribe the syringes for self-use from Monday (July 17). Questions and answers on this.

What kind of preparation is it?

To "Wegovy", a prescription drug for losing weight and maintaining weight. It is currently available in the USA, Denmark and Norway. According to the manufacturer Novo Nordisk, doctors can also prescribe it to obese patients in Germany from Monday, and pharmacies can then also order it from wholesalers. Novo Nordisk anticipates high demand and limited supply.

How does it work?

Patients can inject "Wegovy" under their skin once a week using a pre-filled pen that looks a bit like a highlighter: on their abdomen, thighs or upper arms. The injection solution with the active ingredient semaglutide has also generated great interest in the USA because of some celebrity statements. Novo Nordisk speaks of hundreds of thousands of users.

For which patients is "Wegovy" suitable?

The preparation is intended for adults with a body mass index (BMI) from 30, i.e. obese. BMI is calculated from height and weight. For example, a man who is 1.80 meters tall and weighs 100 kilos is just over the 30 mark. In addition, the drug can also be used in overweight people (BMI from 27) with at least one weight-related concomitant disease such as type 2 diabetes. And in adolescents from the age of 12 who are obese or weigh more than 60 kilos. However, the injections alone should not be the answer for any of these groups: they should rather be a supplement to diet and exercise.

How does the active ingredient work?

Semaglutide mimics the action of the body's hormone GLP-1. "The impulse is set in the brain, so to speak, that one is full," says Jens Aberle, President of the German Obesity Society. According to clinical studies, the active ingredient reduces energy intake and increases the feeling of satiety and fullness, according to a paper by the EU medicines authority EMA. Hunger feelings would be reduced, food cravings less frequent and less severe. If you have a jieper on fries and the like too often, you can apparently get it under control: the preference for particularly fatty foods is reduced.

What are the expectations in Germany?

"The demand is still huge," says endocrinologist Aberle. This applies to "Wegovy", but also to the diabetes drug "Ozempic" with a lower dose of semaglutide, which is often mentioned in the same breath. "Ozempic" is not approved as a weight loss preparation, but it can also be sold for this purpose in so-called off-label use. Delivery bottlenecks also occurred against this background. According to Aberle, the manufacturer has secured 200,000 "Wegovy" pens in Germany for the second half of the year: "That's a good amount, so you could treat a significant number of patients with it."

How much and how fast can you lose weight with it?

According to a study in the "New England Journal of Medicine" with a total of almost 2,000 participants, "Wegovy" subjects had lost an average of 15 percent after 68 weeks. The comparison group only achieved a loss of a good two percent with a dummy drug. Experts clearly advise against use by people of normal weight who, for example, want to get rid of a few love handles before a beach vacation. The relationship between benefit and risk is then wrong. "A conscientious doctor would not prescribe the drug to people of normal weight," says Aberle. There is also the risk that the sick will find it harder or impossible to get their medication if there is an excessive run on it by healthy people.

Who bears the costs?

Health insurance patients in Germany who want to use "Wegovy" first have to pay for it themselves. In particular, drugs that are used to lose weight, curb appetite and regulate body weight are excluded from the possibility of being prescribed at the expense of statutory health insurance under the current regulations. "Hopefully, the regulation will be changed soon so that at least some obese patients can be supplied with it on a prescription," says Aberle. The German Obesity Society is committed to covering the costs in cases in which "Wegovy" is medically indicated, for example when other therapy options do not help.

What will the therapy cost?

Novo Nordisk states the pharmacy sales price of a 4-week ration for the highest dose (2.4 mg) at a good 300 euros. That's too much for self-payers, especially because the drug only works as long as it's taken, says Aberle. The doctor is also expecting study results this year on the extent to which "Wegovy" helps to prevent some of the complications associated with obesity. These could possibly provide arguments for a cost assumption.

What are possible side effects?

In previous studies, subjects reported nausea, diarrhea, constipation and vomiting most frequently. Because of such gastrointestinal side effects, the dose of the drug should be increased to 2.4 mg over several weeks. In four clinical studies, 2650 adults were treated with "Wegovy", the duration was 68 weeks. The manufacturer also mentions possible side effects on its website, such as inflammation of the pancreas, gallstones, a risk of low blood sugar and blurred vision in type 2 diabetics. The safety committee of the EMA is also currently examining data on "Wegovy", among other things, about the risk of suicidal thoughts and thoughts of self-harm. However, according to the EMA, it is not yet clear whether the reported cases are related to the medicines themselves or to the patients' underlying diseases or other factors.

Who should not take "Wegovy"?

The effectiveness has not been studied for a number of people with certain diseases, such as type 1 diabetes. According to the EMA, the preparation must not be used during pregnancy and breastfeeding. Anyone who wants to have a child must discontinue semaglutid at least two months in advance. According to the manufacturer, those people who already had a certain form of thyroid cancer themselves or in the family should not get "Wegovy". This also applies to serious allergic reactions to semaglutide or other ingredients. The manufacturer also points out that the drug can affect the way other drugs work because it slows down gastric emptying.

Are there alternatives?

Other similar drugs are likely to be added, Aberle expects. According to him, the type 2 diabetes drug "Mounjaro" could also be approved for use against obesity by the beginning of 2024 at the latest. According to current knowledge, it is even more effective than "Wegovy" in obesity therapy. Other active ingredients are in development.

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