The Drug in Wegovy is not Nearly as Good as Optimal Medical Therapy for Patients with Type 2 Diabetes
Both Wegovy and Ozempic contain semaglutide and both are made by a Danish company, Novo-Nordisk. Wegovy is approved to treat obesity and comes in a higher dose of 2.4 mg. Ozempic is approved to treat type 2 diabetes. Ozempic is given in lower doses of 0.5 mg, 1 mg., and 2 mg. Patients with type 2 diabetes who have chronic kidney disease are a very high-risk group. Most of them die of heart attacks and strokes before they lose enough kidney function to need dialysis.
A new study in the New England Journal of Medicine compares the effects of an injection of Ozempic 1 mg. with an injection of placebo over three and a half years in patients with type 2 diabetes and chronic kidney disease. It lowered the risk of cardiovascular death by 29% and all-cause death by 20%. The risk of cardiovascular events was 18% lower. 87 patients on semaglutide progressed to dialysis vs 100 on placebo. A non-fatal heart attack occurred in 52 patients on Ozempic vs 64 on placebo. That is a 20% risk reduction. A non-fatal stroke occurred in 63 patients on Ozempic vs 51 on placebo. That is actually a 22% increased risk.
A very similar study compared optimal medical therapy (OMT) for patients with type 2 diabetes and chronic kidney disease over twenty years ago. OMT is a comprehensive approach that combines aggressive goals for blood pressure, sugar, and cholesterol with counseling to stop smoking and aspirin to prevent clot if you are high risk. This analysis occurred at 7.8 years into the study
In the OMT group, there were 5 non-fatal heart attacks vs. 17 in the usual care group. There were 3 nonfatal strokes vs 20 in usual care. There were 5 bypass grafts vs 10 in usual care. These are not fractional reductions. They are multiple. It is an order of magnitude different. There were three times as many heart attacks in the usual care patients and seven times as many strokes.
Thirteen years into the OMT study, the benefits are even greater. There were 4 times as many heart attacks, 5 times as many strokes, and six times as many patients moving to dialysis in patients on usual care compared with patients on OMT.
Wegovy and Ozempic are on fire because of slick, aggressive ad campaigns that promote their effectiveness as weight loss agents. Because OMT is cheap and does not generate much money, no one is paying to promote that, but that is the path to better results at lower cost. Patients on OMT using metformin rather than Ozempic or Wegovy are far more protected from heart attack and stroke compared with patients on the more expensive drugs. That is the main issue in treating patients with type 2 diabetes who have chronic kidney disease. It is not only losing weight and lowering the glucose that matters, the components of OMT protect every cell and organ in the body to prevent heart attack, stroke, and dialysis. Metformin costs $4 a month at Walmart with no insurance. Wegovy costs $1406 and Ozempic is $1114. The companies lure you in with a discount, but your employer pays big money for these drugs. I can’t find out just how much they are paying and neither can you.
The cost-benefit calculation on these drugs is horrible. I have treated many patients like this. Sixty percent of my type 2 diabetes patients lost weight even though most of them were high-risk individuals. The average weight lost was 13 pounds at a year and 15 pounds at two years. Four of them lost over 100 pounds. OMT is far more cost effective than Wegovy and Ozempic.
When prescribed, Wegovy/Ozempic/Mounjaro which is even more effective than the previoous two, should be prescribed on top of Westerman's optimal medical therapy. BUT, as we both have said, by diet, exercise, determination, alone, none of these medications are even necessary. HRS, MD, FACC
Thank you