The approval, by the National Health Surveillance Agency (Anvisa), of the new drug for the treatment of obesity, has brought hope to patients seeking weight loss treatments. Semaglutide was already used in Brazil for the treatment of type 2 diabetes and can now also be used in the treatment of overweight and obesity, in the form of an injectable drug.
There is, however, a difference in dosage. While for glucose control the applied semaglutide ranges from 0.5 milligram to 1 milligram, for weight reduction the substance is 2.4 milligrams. Semaglutide belongs to the same family as liraglutide, which is also used in both treatments. But the difference between 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 dietary habits. When weight loss greater than 5%, up to 15%, is needed, lifestyle changes and drug therapy are combined. The novelty is that semaglutide can reduce it by more than 15% ”, explains the doctor Paulo Miranda, president of the Brazilian Society of Endocrinology and Metabolism (SBEM).
How does it work
The drug works in the patient’s brain, in a region called the hypothalamus, and increases the perception of satiety. Thus, the patient has a reduced appetite and, as a result, eats less. According to the endocrinologist of the University Hospital of Brasilia (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 system, which are substances that act on our central nervous system, reducing appetite, increasing satiety and reducing energy expenditure. This medicine mimics what these substances do, which already exist in the body,” he explains.
Recommendation
Treatment with this drug is indicated for obese or overweight patients. 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 HUB endocrinologist, semaglutide can be used as a first strategy for weight loss, provided the above indication criteria are met. He reminds, however, that the use of the drug must be accompanied by other measures, such as changes in eating habits and physical exercise. And all treatment must be supervised by a doctor.
Dr. Paulo Miranda adds that semaglutide appears to fill a gap in possible treatment levels up to bariatric surgery, used for the most severe cases of obesity. “Bariatric surgery is indicated for patients with indications of weight loss from 30% of body weight. Semaglutide does not replace the bariatric one, because it has different results. Help patients lose weight with lifestyle changes and medications before resorting to bariatrics. And if the response is adequate, then there is no need for surgery,” he said.
Estimated cost
Semaglutide 2.4mg was recently approved in Brazil, so it is not marketed yet. Therefore, 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, semaglutide can be found with prices ranging from R$800 to R$1,000, the price of a monthly treatment.
“Since this substance is already approved and marketed in Brazil for the treatment of diabetes, for glucose control, we already have an idea of the costs. However, the doses for the treatment of obesity are higher than for the control of diabetes, which already has a high cost. So the expectation is that the cost will be higher,” the endocrinologist said.
Searches
For the doctor 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 follow in the field of drug research and other novelties could emerge in the coming years.
“In the United States they are already experimenting with a new cure, another drug that could enter the market in the near future and which induces a loss of more than 20% of body weight. We are in a process, on a journey. I would not call semaglutide a revolution. I would define it as a great evolution, one more step as we take this journey in search of weight loss treatments”.
