Diabetes: limited access to Ozempic, a loss of opportunity for patients? - In the news

2023-12-11 16:25:56

December 11, 2023

The ANSM now recommends the prescription of Victoza, Ozempic and Trulicity, GLP-1 analogues used in the treatment of diabetes, only to patients already under treatment. “A loss of opportunity for patients at high cardiovascular risk,” regrets Jean-François Thébaut, cardiologist, vice-president of the French diabetics federation.

Last week, the Novo Nordisk laboratory recommended that health professionals no longer prescribe new treatments with Ozempic, a GLP-1 analogue which plays a major role in the treatment of patients suffering from type 2 diabetes. The laboratory thus temporarily suspends the distribution of Ozempic as an initiation dose in the city and in hospitals. He also announced to reduce the production of Victoza, an analogue of the first generation GLP-1. Trulicity, another analogue manufactured by the Lilly laboratory, is also experiencing significant supply tensions, reported the National Medicines Safety Agency (ANSM) on Friday December 8. These tensions are expected to last throughout 2024 as the three drugs have seen a sharp increase in global demand in recent months.

Consequently, the ANSM now recommends no longer prescribing Ozempic, Victoza or Trulicity as an initiation of treatment and reserving it for patients already under treatment.

GLP-1 is an intestinal hormone that is involved in the regulation of blood glucose. Insufficient in people who suffer from diabetes, the GLP-1 analogue is an injectable drug which has the dual advantage of improving glycemic balance and good cardiovascular protection. “It’s thanks to these medications that we no longer die from diabetes,” notes Dr. Jean-François Thébaut, cardiologist, vice-president of the French Federation of Diabetics. “We die from cardiovascular, renal or neurological complications of diabetes. And the leading cause of death in diabetic patients is cardiovascular complications. »

Medications that are very effective in balancing blood sugar levels

So the new recommendations from the ANSM worry the doctor. “The recommendations of the French-speaking diabetes society specify the preponderant place of these drugs (GLP-1 analogues) in the therapeutic strategy and in particular, taking into account their demonstrated effects on the reduction of cardiovascular mortality. In addition, these medications are among the most effective in regulating blood sugar levels,” explains the doctor, contacted by Destination Santé.

The vice-president of the French federation of diabetics adds: “in a patient who presents significant atherosclerotic risk factors (heart attack, stroke) only GLP1 analogs have shown effectiveness with a reduction of almost 20% in mortality. A patient with a heart attack who has uncontrolled diabetes should be treated with a GLP-1 analogue. Not prescribing to him is, for him, a waste of opportunity.”

Atheromatous disease is characterized by the formation of atherosclerotic plaques on the walls of the arteries and the rupture of these plaques, the fragments of which can block the arteries. For the patient, the risk is vascular accident (myocardial infarction, stroke).

A less effective alternative?

In its publication, the ANSM offers an alternative : “when the initiation of treatment is motivated by the presence of a proven atheromatous disease and aims to reduce the risk of occurrence or recurrence of a cardiovascular event: SGLT2 inhibitors (iSGLT2) must be prescribed as an alternative to a aGLP-1 “. For Jean-François Thébaut, “SGLT2 works well in a person with well-controlled diabetes for whom we want to provide cardiovascular prevention. These medications are effective in preventing heart failure and kidney failure but not atheromatous disease.”

In France in 2020, according to figures from Public Health France, more than 3.5 million people are treated with medication for diabetes, or 5.3% of the population.

Source : Public Health France, ANSM, Interview with Jean-François Thébaut, December 11, 2023.
Written by : Dorothée Duchemin – Edited by Emmanuel Ducreuzet