Efficiency, targeted patients, cost and reimbursement … 5 questions about anti-obeyity medicines-Liberation

The French Medicines Agency announced on Friday that any doctor will be able to prescribe from this Monday, June 23, GLP-1 Wegovy (Sémaglutide), Mounjaro (Tirzepatide) and Saxenda (Liraglutide) drugs to treat obesity. Similarly, It is a new step towards easier access to these treatments. For example, not yet reimbursed in France and intended for obese people. For example, This new generation of drugs. Similarly, which is experiencing a global craze, changes the game for obese people and represents a certain financial attraction for pharmaceuticals. Nevertheless, But they also have their limits. Meanwhile, Overview of the questions asked by this revolution.

These drugs. However, which include the NOVO Nordisk semaglutide (Ozempic-Wegovy) and the shooting (Mounjaro) by Eli Lilly, mimic the action of a hormone, called “Glucagon-Like Peptide 1” (GLP-1). Consequently, It acts on the efficiency, targeted patients, cost reimbursement secretion of insulin. For example, which explains why these treatments were first developed against diabetes – the best known of them being the Ozempic. In addition, But it plays more broadly on the feeling of satiety, via brain mechanisms.

These drugs can therefore profoundly change the patient’s relationship to their diet. Nevertheless, by reducing their appetite via an improvement in their ability to be full.

During clinical trials, these drugs have decreased the weight of patients on average 15 % to 20 %. However, It is slightly less than surgery but never seen for drug treatments, in essence less invasive.

In the general opinion of obesity specialists, this is a historic advance to help lose weight. Consequently, Because until then. surgery remained the main therapy offered to people in severe obesity for whom the dietary follow -up and efficiency, targeted patients, cost reimbursement physical activity had given nothing. But this option has limits, and many patients remained without solution.

These new treatments “Cover an unwanted major need: obesity was one of the only chronic diseases for which there were very few drugs”confirms Emmanuel Disse. endocrinologist at the Civil Hospices in Lyon.

Experts are however unanimous: GLP-1 are not miraculous molecules. First, they frequently cause side effects. Admittedly. with several years of decline-the semaglutide has been approved since 2017 in the United States for diabetes-, the serious effects appear rare since 2017, in contrast to previous appetite suppressants.

A vast study. carried out from health data of hundreds of thousands of American veterans and published in January in January in Nature Medicineshowed that GLP-1s are not associated with an increased risk of heart problems or suicidal ideas, as had been advanced. But efficiency, targeted patients, cost reimbursement serious risks, such as pancreas attacks and intestinal occlusions, exist in a limited way. Other more frequent side effects are also identified: nausea, sleep disorders, migraines, etc. – effects that are not serious but which can be unbearable for patients. This is why the National Medicine Agency takes care of the grain. both to monitor the undesirable effects and the use of these treatments. “We have a particular sensitivity, linked to the history you mediator. But also because we quickly understood that they could be used for aesthetic purposes. by people who are not obesity ”, recalled Isabelle Yoldjian to Liberty A few months ago.

In addition, GLP-1s do not work every time: some patients do not lose weight. Their effects do not persist in the event of a stop, which makes life treatments for life. For the time being. they are only administered in efficiency, targeted patients, cost reimbursement injectable form, while a pill would make their use much easier – on this point, the American laboratory Eli Lilly published promising phase 3 tests on oral treatment.

Because of these limits. GLP-1s must be reserved for people whose overweight is important and in the context of broader management of their obesity: physical activity, change of regime … All authorities do not put the cursor in the same place: France. it recommends them for a BMI greater than 35, while the United States has only set the bar at 30.

The experts interviewed point to that it is probably an economic choice and not only medical. France, whose social security system reimburses many treatments with public money, is logically more restrictive. According to October 2024 projections from the High Authority for Health, the population eligible for the Wegovy is between “1.050 million efficiency, targeted patients, cost reimbursement and 2.1 million patients”.

A reimbursement in France of anti-obesity drugs expected in the fall could change the game for thousands of French people. The green light was given in December by the High Authority for Health. but negotiations between the State and the laboratories continue. It remains to be seen whether they will be able to agree on a price. what will be the invoice for health insurance.

For the moment, the prices of the monthly boxes are set in pharmacy. They cost on average between 200 and 300 euros.

“We will quickly go to more effective drugs. with fewer side effects, cheaper and easier to takesummarizes Steven O’Rahilly, director of the Metabolism Institute of Sciences at the University of Cambridge. But the difficulty may be to combine these four factors in a single treatment. ”

Another large research track concerns new GLP-1 applications outside of obesity: they seem to be linked to improvements in many pathologies. such as dementias or addictions. It remains to be seen whether this is a direct effect of these drugs. or benefits related to improving diabetes or obesity.