Text | Zhongtong Media reporter Jing Jing
Recently, the National Health Insurance Administration released the 2023 edition of the National Medical Insurance Drug Catalog, which contains a total of 3,088 drugs, covering more than 90% of the drug share of public hospitals across the country, of which semaglutide injection is one of them.
Semaglutide, the "miracle drug for weight loss", has become popular again, and with the blessing of the medical insurance system, it has successfully stimulated the weight loss market and caused a new round of weight loss frenzy. And as a drug for diabetics, how can it be targeted by the weight loss market?
This also starts with semaglutide itself.
Semaglutide
Semaglutide is a novel long-acting glucagon-like peptide-1 (GLP-1) analogue that was originally extracted from natural hypoglycemic substances from anglerfish and poisonous lizards and inhibits the release of glucagon, which can raise blood glucose. In 2021, the China Food and Drug Administration approved semaglutide for the treatment of adults with type II diabetes and to reduce the risk of adverse cardiovascular events in patients with type II diabetes and cardiovascular disease.
Semaglutide has obvious requirements for use in terms of use method and dosage, and it needs to be used under the guidance of a doctor. On the label of semaglutide, the main adverse reactions are listed: "The most commonly reported adverse reactions in clinical trials are gastrointestinal disorders, including nausea (very common), diarrhoea (very common) and vomiting (very common). "Very common" means that at least 1 in 10 users have reported the adverse reaction, and "common" means that 1 in 100 people have reported the adverse reaction.
In the more than 40 years since the discovery of semaglutide, there have been clinical and scientific studies that have proved several major effects of semaglutide.
Functions and processes
Lowers blood sugar
At present, semaglutide is mainly used for hypoglycemic effect, which is also the main application field of semaglutide in China. Studies have shown that GLP-1 is mainly secreted by L cells and pancreatic α cells in the intestine in vivo, regulates blood glucose through a variety of pathophysiological mechanisms, promotes the synthesis and secretion of insulin by pancreatic β cells, inhibits the apoptosis of pancreatic β cells, and improves the function of pancreatic islets.
Compared with other types of hypoglycemic drugs, it has advantages in the mode of administration and the degree of hypoglycemia. As a hypoglycemic drug, semaglutide has 94% homology with human natural GLP-1 compared with metformin, with a long half-life, few adverse reactions, and high clinical drug safety.
Suppressed appetite
Semaglutide acts on the human body through insulin, and obesity is closely related to insulin. Semaglutide slows the rate of gastric emptying by significantly increasing satiety signals in the arcuate nucleus of the hypothalamus, which helps to increase satiety and reduce the frequency of meals and snacking intake, which is similar to most weight loss products on the market.
On December 4, 2020, Novo Nordisk submitted a marketing application to the U.S. Food and Drug Administration (FDA) for semaglutide 2.4mg subcutaneously administered once a week for weight loss.
In 2021, the US FDA officially approved semaglutide injection for chronic weight management in obese or overweight adults. However, there are strict restrictions on who can use it and how much it can be used.
Adults with an initial body mass index (BMI) of ≥ 30 kg/m2 (obesity), or adults who ≥ 27 kg/m2 and < 30 kg/m2 (overweight) and have at least one overweight-related condition (hypertension, type 2 diabetes, or high cholesterol). And the FDA has also reached clear regulations on the dosage of semaglutide injection, which needs to reach 2.4mg for weight loss.
But in fact, many people who use semaglutide abroad for weight loss have rebounded sharply after stopping the drug.
Treat cancer
With the semaglutide boom, research on semaglutide has also begun to heat up. In May 2023, according to the "Obesity" literature, semaglutide has the function of restoring natural killer cells (NK cells) in the body.
However, the production of NK cytokines is dependent on intrinsic cellular metabolism, and the CD98-mTOR-glycolytic metabolic axis in NK cells in obese patients before and after treatment with GLP-1 is significantly enhanced, that is to say, the metabolism of NK cells in obese patients after GLP-1 treatment is improved, and semaglutide treatment once a week can increase the levels of IFN-γ and granzyme B (which can induce tumor cell apoptosis), which can further reduce the risk of cancer.
And the study in Alzheimer's & Dementia found that the risk of dementia was 53% lower in the group treated with GLP-1 receptor agonists than in the control group.
However, at present, there is still a lack of sufficient clinical trial data to support whether semaglutide can truly alleviate the symptoms of patients with early Alzheimer's disease.
Adverse effects
Semaglutide also has side effects during use. The Journal of the American Medical Association reported that semaglutide gastrointestinal adverse events were reported in 84.1%, and common adverse reactions included nausea, diarrhea, vomiting, constipation, abdominal pain, bloating, dizziness, headache, dyspepsia, hypoglycemia, gastroenteritis, and gastroesophageal reflux disease.
In addition, due to individual differences, some people may also have serious adverse reactions such as acute kidney injury, retinal damage, hypersensitivity reactions or tumors after medication. Therefore, whether it is domestic or foreign, the use of semaglutide requires the use of pharmacists or physicians.
Thanks to the adjustment mechanism of the national medical insurance drug catalogue of "one adjustment per year", as a long-term drug for diabetic patients, semaglutide was included in the national medical insurance catalogue as early as April 2021, and the reimbursement according to the medical insurance ratio is less than one-tenth of that of the United States, and the pricing is much lower than that of foreign countries, which also significantly reduces the cost burden of patients. Statistics show that from January to February this year alone, semaglutide was reimbursed more than 700,000 times in the national medical insurance.
However, the "Interim Measures for the Administration of Drugs in Basic Medical Insurance" also clearly stipulates that life-improving drugs such as weight loss cannot be included in the scope of reimbursement. Therefore, is the weight loss effect of semaglutide a refurbishment of old drugs or a new trend in the market?
Bibliography:
1.Glucagon-like peptide-1 therapy in people with obesity restores natural killer cell metabolism and effector function
2.De Barra C, Khalil M, Mat A, O'Donnell C, Shaamile F, Brennan K, O'Shea D, Hogan AE. Glucagon-like peptide-1 therapy in people with obesity restores natural killer cell metabolism and effector function. Obesity (Silver Spring). 2023 May 9. doi: 10.1002/oby.23772. Epub ahead of print. PMID: 37157931.
3.Nørgaard CH, Friedrich S, Hansen CT, Gerds T, Ballard C, Møller DV, Knudsen LB, Kvist K, Zinman B, Holm E, Torp-Pedersen C, Mørch LS. Treatment with glucagon-like peptide-1 receptor agonists and incidence of dementia: Data from pooled double-blind randomized controlled trials and nationwide disease and prescription registers. Alzheimers Dement (N Y). 2022 Feb 23; 8(1):e12268. doi: 10.1002/trc2.12268. PMID: 35229024; PMCID: PMC8864443.