4 min readChandigarhDec 4, 2024 10:24 AM IST
First published on: Dec 4, 2024 at 10:24 AM IST
Recently, Danish drugmaker Novo Nordisk shared the initial news about CagriSema, the next generation of semaglutide, sold as Ozempic for the treatment of diabetes, and Wegovy for obesity, as a game-changer. It has been predicted to reduce weight loss by about 25 per cent in half the time that Wegovy takes. But can these new drugs replace conventional treatments for diabetes on a large scale?
That’s the question that Dr KP Singh, former faculty, the Department of Endocrinology, PGI and currently the Director, Endocrinology, Fortis Hospital, Mohali, has raised, arguing why we should not ignore conventional drugs and therapies. “GLP-1 receptor agonists like semaglutide have revolutionised the approach to treating both diabetes and obesity. But keep in mind that most patients are still managed by oral medications to treat diabetes and not injections, at least in the early stages,” he explains.
Who should use these drugs?
These drugs aren’t simply “weight loss shots”, done on a whim. There are enough examples of how they have gone wrong in people who simply wanted to knock off the pounds and who were riddled with side effects like gastro-intestinal problems. Last year’s study in the journal Obesity had revealed that of people prescribed weight-loss drugs, just 44 per cent were still taking them after three months and only 19 per cent after one year.
Another study showed that those who stopped treatment with Mounjaro (another GLP-1 drug) regained around 60 per cent of their lost weight. Just as these drugs drive you to lose weight, their withdrawal can push you to return to old habits faster than you think. Besides, can you continue on these drugs lifelong?
Frankly, these are medical interventions intended for patients with diabetes, obesity or weight-related health conditions and are especially beneficial for patients with heart disease. These medications are not appropriate for cosmetic weight loss or short-term use.
Is the weight loss conversation overplayed?
The drugs are very effective with clinical trials of semaglutide showing average weight reductions of around 15 per cent in clinical trials. However, we must remember that obesity is a complex chronic disease requiring comprehensive management. These medications work best as part of a holistic approach including dietary modifications, physical activity and behavioural changes. The maximal benefit of these drugs requires continuous long-term use and grading the dose over time to maintain or attain a specific response or to decrease the risk of adverse effects.
Are conventional therapies for diabetes becoming irrelevant?
No. Conventional therapies still have a major role to play in diabetes management as these injectable drugs should be considered first-line therapy in patients with heart disease and those who require an injectable medication from the get-go. Despite GLP-1, many patients will require multiple medications to control their blood sugars and achieve their goal.
Also, pregnant women, patients with acute complications from diabetes, or patients who need to control their blood sugar levels rapidly (e.g. leading up to major surgery) still require traditional diabetes medications like insulin. Patients with pancreatic disease, Type 1 diabetes, gallstones or those with tumours of the endocrine glands should not take GLP1 drugs.
How is CagriSema different from Ozempic and Wegovy?
The active ingredient of Ozempic and Wegovy is semaglutide, a glucagon-like peptide-1 receptor agonist (GLP-1 RAs). This mimics the gut hormone GLP-1, which promotes the production of insulin, regulates blood sugar levels, slows the emptying of the stomach, and affects the area of the brain that controls satiety. CagriSema, in addition to mimicking GLP-1, mimics two other gut hormones. The first is amylin, a hormone that is co-secreted with insulin in the pancreas and regulates blood sugar levels, slows digestion and enhances satiety.
It also mimics calcitonin, a hormone that regulates calcium levels in the blood. Calcium plays a role in insulin secretion. Looking ahead to CagriSema – it is currently under investigation and our centre is a major site for key clinical trials investigating its use in many clinical conditions. The data from early-phase trials is promising, but we must maintain scientific rigour in assessing all new treatments. We will need the results from the ongoing large trials to assess the efficacy and long-term safety profile of CagriSema and wait for approval from regulatory bodies
The drugs are very effective with clinical trials of semaglutide showing average weight reductions of around 15 per cent in clinical trials. (Representational image/File) 
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