The approval, by the National Health Surveillance Agency (Anvisa), of a new drug to treat obesity, brought hope to patients seeking treatment for weight loss. Semaglutide was already used in Brazil for the treatment of type 2 diabetes and now it can also be used in the treatment of overweight and obesity, in the form of an injectable medication.
There is, however, difference in dosage. While for glucose control the semaglutide applied is 0.5 milligrams to 1 milligram, for body weight reduction the substance is 2.4 milligrams. Semaglutide is from the same family as liraglutide, which is also used in both treatments. But the differential of the drug approved by Anvisa earlier this year is its effectiveness.
Semaglutide is seen among physicians as a breakthrough in the treatment of obesity. This is because the other existing drugs allow a maximum weight loss of 10%. “When the patient has an indication of weight loss of less than 5% of body weight, the best indication is a change in eating habits. When there is a need for weight loss of more than 5%, up to 15%, lifestyle changes and pharmacological therapy are combined. What is new is that semaglutide can reduce it by more than 15%”, explains physician Paulo Miranda, president of the Brazilian Society of Endocrinology and Metabolism (SBEM).
How it works
The drug acts in the patient’s brain, in a region called the hypothalamus, and increases the perception of satiety. Thus, the patient has a decreased appetite and, consequently, eats less. According to the endocrinologist at the University Hospital of Brasília (HUB) Monalisa Azevedo, semaglutide reproduces the effects of substances present in our body.
“In our body there is the production of some substances, by our digestive tract, which are substances that act on our central nervous system, reducing appetite, increasing satiety and reducing energy expenditure. This medicine mimics what these substances, which already exist in the body, do, ”he explains.
Recommendation
Treatment with this drug is indicated for patients who are obese or overweight. The patient must have a Body Mass Index (BMI) of 30 or more or a BMI of 27 and obesity-related health problems such as hypertension, diabetes, cardiovascular disease or obstructive sleep apnea. BMI is calculated by dividing body weight (kg) by height (m) squared. That is, BMI = kg/m².
According to the endocrinologist at the HUB, semaglutide can be used as the first strategy for weight loss, as long as the aforementioned indication criteria are met. She recalls, however, that the use of the drug must be accompanied by other measures, such as changing eating habits and physical exercise. And all treatment must be supervised by a doctor.
Doctor Paulo Miranda adds that semaglutide appears to fill a gap in possible treatment levels up to bariatric surgery, used for more severe cases of obesity. “The bariatric surgery is indicated for patients with an indication of weight loss from 30% of body weight. Semaglutide does not replace the bariatric one, because it has different results. She helps patients lose weight, with changes in habits and therapy, before resorting to bariatrics. And if the response is adequate, then there is no need for surgery,” he said.
Estimated cost
The 2.4 mg semaglutide was recently approved in Brazil, so it is not yet being marketed. Thus, it is not possible to say how much a treatment with the substance would cost. However, the expectation of doctors is that it is not a treatment accessible to everyone. For the treatment of diabetes, it is possible to find semaglutide with prices ranging from R$800 to R$1,000, the price of a monthly treatment.
“As this substance is already approved and marketed in Brazil for the treatment of diabetes, for glucose control, we already have an idea about costs. However, the doses for treating obesity are higher than the doses for controlling diabetes, which already has a high cost. So the expectation is that the cost will be higher”, said the endocrinologist.
Researches
For physician Monalisa Azevedo, the effectiveness of the substance in weight loss can be considered an evolution, but not a revolution in treatment. This is because, for her, there is still a path to be followed in the field of drug research and other innovations may emerge in the coming years.
“In the United States, they are already testing a new treatment, another drug that will possibly enter the market in the near future, and that induces a loss of more than 20% of body weight. We are in a process, on a journey. I wouldn’t call semaglutide a revolution. I would call it a great evolution, one more step that we climb on this journey in search of treatments for weight loss”.
