Nordic Life Science 1
COMMENTARY // OBESITY It is no secret that obesit
y is one of the biggest public health challenges of the 21st century and is one of the leading causes of preventable death globally. It’s estimated that 18% of the global population is obese, with the prevalence of obesity in the Nordics at somewhere between 15% to 21%, with these numbers only expected to rise. T E X T B Y J E N N I F ER L E E S , CON S U L T A N T, IQV I A U NSURPRISINGLY, the arrival of the GLP-1 receptor agonists as weight loss medications have captured the world’s attention as potential solutions. This is the first time that pharmacological interventions have shown to deliver meaningful weight loss. The large diabetes companies Novo Nordisk and Lilly are currently leaders in the obesity market. The obesity pipeline has more than 80 clinical-stage assets that are being investigated in trials. GLP-1s, on their own or in combination with GIP agonists, account for 35% of current candidates. Glucagon/GLP-1R dual agonists and glucagon/GLP-1R/GIP triple agonists account for 21% of the obesity pipeline, while amylin analogues represent 15%. The remaining 29% includes a range of different mechanisms of action, such as, SGLT2, MGAT2, MC4R, PDE5, PYY, and insulin-receptor modulator. As competition heats up, ultimately head-tohead trials will be needed to demonstrate unambiguous differentiation, which Lilly and Novo have both recently embarked on with Lilly’s SURMOUNT-5 obesity trial and Novo’s REDEFINE 4 trial. Real World Data will also be crucial to understand the long-term value, not only in reducing obesity, but also in obesity-related comorbidities. It is safe to say that the obesity market has shaken up the pharmaceutical industry, which is seeing unusually high levels of out-of-pocket spend. However, despite the present optimism in the market, the future progress of these weight-loss treatments is far from linear. One of the largest challenges facing the market is how these treatments will be funded in the future. While patients are currently showing a large willingness to pay out of pocket for these medications, it raises concerns of equity of access as well as uncertainty regarding the willingness to pay out of pocket in the future, once the novelty of these treatments wears off. A t present, there is a general reluctance from payers around the globe to reimburse these treatments due to the vast cost it would put on healthcare systems. With that said, the FDA has recently decided to partially reimburse the use of Wegovy in overweight and obese patients with cardiovascular disease at risk of stroke and heart attack. Other countries will be very eager to learn about the impact of reimbursed usage on both patient outcomes and overall healthcare costs. Innovative contracting models such as subscription and volume-based models are being discussed internationally to find opportunities for reimbursement within feasible budgets. In the Nordics, Saxenda and Wegovy are available in all countries for patients to pay, largely, out of pocket and Mounjaro is expected to become available towards the end of 2024. There has been some success for reimbursement NORDICLIFESCIENCE.ORG | 39