Healthcare in 2024 saw significant advances across multiple specialisations.
Weight loss treatments have seen remarkable breakthroughs, and cancer treatment is undergoing radical transformations with immunotherapies and personalised treatments.
mRNA technology, which proved vital during the pandemic, continues to demonstrate its potential far beyond Covid vaccines. And exciting developments in gene editing are opening new doors to fix genetic disorders and improve targeted treatments.
Novo Nordisk’s Ozempic, containing semaglutide, which was approved by the US FDA in 2017 for treatment of type 2 diabetes, soon gained attention for off-label use in weight loss. In 2021, the Denmark-headquartered company launched Wegovy, a semaglutide pen-injection, which became the first FDA-approved drug for long-term weight management in almost a decade.
In November 2023, Eli Lilly’s Zepbound (containing tirzepatide, also a GLP-1 receptor agonist like semaglutide) received FDA approval for obesity treatment. This followed the success of Lilly’s Mounjaro (tirzepatide), an injectable diabetes drug that is also used off-label for weight loss.
Both Wegovy and Zepbound boost GLP-1 levels, targeting signals in the gut and brain, so the user feels full. Zepbound also enhances levels of GIP (gastric inhibitory polypeptide), another hormone that the body releases after a meal to induce the feeling of being full.
TRIAL RESULTS THIS YEAR: This March, FDA approved the use of Wegovy for reducing the risk of heart attacks and strokes in overweight or obese adults with cardiovascular disease. This first approval for a therapy to address both weight management and cardiovascular risk was based on the SELECT trial, which showed a 20% reduction in such risks compared to a placebo.
- That same month, Novo Nordisk announced results from its FLOW trial, where semaglutide (1.0 mg) reduced kidney-related complications by 24% in people with type 2 diabetes and chronic kidney disease (CKD). Since about 40% of diabetics also have CKD, this was a significant finding. The European Medicines Agency (EMA) has allowed a label update to include this benefit, and the FDA is expected to make a decision next month.
- In December, Novo Nordisk revealed promising results from its REDEFINE 1 trial testing CagriSema, a combination of cagrilintide and semaglutide. After 68 weeks, the drug showed superior weight loss compared to a placebo. Results from a REDEFINE 2 trial focused on people with type 2 diabetes and obesity are expected in 2025.
- Also, Eli Lilly announced that Zepbound is approved as the first prescription drug for adults with obesity and moderate-to-severe obstructive sleep apnoea (OSA). Clinical trials have shown an average weight loss of up to 20% and significantly fewer breathing interruptions during sleep. Remarkably, 50% of participants no longer had OSA symptoms after a year, the company said.
- In August, Lilly released data from its SUMMIT trial, which evaluated tirzepatide in patients with heart failure with preserved ejection fraction (HFpEF) and obesity. HFpEF is a condition in which the heart struggles to pump efficiently, leading to fatigue and reduced exercise ability. The company plans to seek regulatory approval for this new use soon.
- In June, Lilly had published results from its SYNERGY-NASH phase 2 trial, which studied tirzepatide in adults with MASH, a chronic liver disease where a fat buildup in the liver triggers inflammation. According to the company, over half of participants showed improved liver fibrosis compared to those who were given a placebo. MASH is the second leading cause of liver transplants in the US.
CHEAPER GENERICS ON THE WAY: The surge in demand for these drugs is expected to ease soon. The fundamental patent covering semaglutide expires in early 2026, and Chinese manufacturers are gearing up to produce cheaper generic versions.
In July, an expert committee of India’s drug regulator approved tirzepatide for chronic weight management, with a key condition: the company must conduct a phase IV clinical trial — that is, a post-marketing study that will monitor side effects missed in earlier trials, and assess the drug’s long-term performance in India’s diverse population.
Lilly is expected to launch Mounjaro in India in 2025, depending on the global supply availability. Novo Nordisk too, is likely to launch its weight-loss drugs in the new year.
Indian generic drug makers are, meanwhile, preparing to manufacture more affordable GLP-1 weight-loss drugs as soon as the patents expire. Several companies have started bioequivalence trials to demonstrate that their generic versions are as safe and effective as the original branded drugs.
Cancer: immunotherapy and personalised treatment
Recent breakthroughs in immunotherapy are changing the way we detect, treat, and understand cancer, providing patients with more effective, less invasive treatments. Immunotherapy teaches the body’s immune system to recognise and attack cancer cells.
CAR-T CELL THERAPY: This year, India launched its first homegrown CAR-T cell therapy called NexCAR19, developed as a collaboration between academia and industry.
The therapy works by taking a patient’s T cells — a type of white blood cells that fight cancer — and genetically modifying them to recognise and destroy cancer cells. NexCAR19 is designed to treat B-cell lymphomas and B-acute lymphoblastic leukaemia in patients aged 15 and older.
This is a major development — NexCAR19 is the world’s most affordable CAR-T therapy, which can make advanced cancer treatments more accessible, and put Indian cell and gene therapy innovation on the global stage.
Bengaluru-based biotech startup Immuneel Therapeutics, which is backed by Biocon founder Kiran Mazumdar Shaw and Columbia University cancer physician Dr Siddhartha Mukherjee, is running clinical trials for a CAR-T therapy called IMAGINE.
In October, Aurigene Oncology Limited, part of Dr Reddy’s Laboratories, published positive results from its first trial of a new CAR-T therapy, Ribrecabtagene autoleucel (DRL-1801), for multiple myeloma, a type of blood cancer. The drug regulator has approved phase 2 of the trial.
CVLP IN THE UK: In England, the NHS Cancer Vaccine Launch Pad (CVLP) has been launched, with a focus on personalised cancer vaccines made using mRNA technology.
In May, the National Health Service announced preliminary clinical trial results of the treatment of the first patient with a tailored vaccine for bowel cancer. These vaccines are created by analysing a patient’s tumour to find unique mutations, helping the immune system target the cancer more effectively.
The trial will be expanded to other cancers such as pancreatic and lung cancer, as most participants join by 2026. Thirty hospitals are part of this groundbreaking initiative, among the largest of its kind, which could transform the treatment of cancers in the future.
HPV SHOT IN INDIA: India will roll out a nationwide human papillomavirus (HPV) vaccination campaign in 2025.
The vaccine protects against strains of the virus responsible for the majority of cervical cancers, as well as some cancers of the anus, vagina, and throat. It also guards against the strains that cause the most genital warts, offering a shield against a wide range of HPV-related diseases.
This is a very important campaign — cervical cancer is the second most common cancer among Indian women; India bears a staggering 20% of the global burden of the disease. Approximately 1.25 lakh women are diagnosed every year, and around 75,000 lose their lives to this preventable disease.
Alzheimer’s disease: new hope from newer drugs
2024 saw encouraging progress in the treatment of Alzheimer’s, the progressive brain disorder that affects millions worldwide. These advances aren’t cures; they underline the importance of early intervention in managing the disease in specific groups of patients.
Alzheimer’s is linked to changes in the brain, including the buildup of amyloid beta plaques. Amyloid is a protein that the body produces naturally, but when it clumps together, it can form amyloid plaques. The buildup of excessive amyloid plaque in the brain is believed to contribute to memory loss and other cognitive issues associated with Alzheimer’s.
Last year, the FDA approved Leqembi (lecanemab), a monoclonal antibody for early Alzheimer’s treatment developed by Eisai and Biogen, and in July this year, Lilly’s Kisunla (donanemab-azbt).
These drugs help the body clear excessive amyloid plaques, slowing down the cognitive decline that affects memory, the ability to manage finances, and remember important dates. However the treatments are only approved for adults in early stages of Alzheimer’s — including individuals with mild cognitive impairment (MCI) and those in the mild dementia stage of the disease.
In India, around 5.3 million people are living with dementia, and Alzheimer’s is one of its most common forms. When the new Alzheimer’s drugs reach India, access and affordability will be major challenges.
The performance of these drugs in larger groups of patients will be watched closely over the next few years. A similar drug, Aducanumab, which was approved by the FDA in 2021 based on early data showing reduction of beta amyloid plaques in brain scans, did not lead to actual improvement in patients’ symptoms.
India is also conducting research to explore potential treatments other than therapies targeting amyloid beta proteins.
Gene editing: advances that promise transformation
In December 2023, the FDA approved two groundbreaking treatments, Casgevy and Lyfgenia, the first cell-based gene therapies to treat sickle cell disease (SCD) in patients aged 12 and older.
In 2024, Boston-based Verve Therapeutics, a company that specialises in gene-editing medicines, announced its experimental therapies VERVE-101 and VERVE-102, which are designed to lower cholesterol by targeting the PCSK9 gene in the liver.
These therapies — aimed at permanently deactivating the PCSK9 gene, which helps regulate cholesterol levels in the blood — are initially being developed for heterozygous familial hypercholesterolemia (HeFH), a genetic condition that causes dangerously high levels of “bad” cholesterol (LDL).
Eventually, these treatments may also benefit patients of atherosclerotic cardiovascular disease (ASCVD), who struggle with high levels of LDL despite other interventions.
The researchers have used CRISPR-based gene-editing to create an infusion that can “switch off” the PCSK9 gene, which controls the production of LDL receptors that help remove LDL cholesterol from the bloodstream.
Kaunain Sheriff M is Health Editor, The Indian Express
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With the end of the Covid-19 pandemic, attention has moved back to the growing burden of non-communicable diseases (NCDs). (Illustration: Suvajit Dey)
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