Fat-busting diabetes drug is a global smash hit but remains prohibitively pricey for many Indians

An oral form of the medicine was granted approval in India by the Central Drugs Standard Control Organisation under the brand name Rybelsus, to treat type 2 diabetes in 2020, and hit the Indian markets in January this year.

But its high costs — a daily dose of one tablet costing upwards of Rs 250 — has meant that the drug is still out of reach for many, say specialists.

Senior diabetologist Dr V Mohan, pointed out that though permitted only as an anti-diabetic agent, Rybelsus does produce some weight loss as well.

“It is not approved as a pure weight loss agent in India and even though Rybelsus has proved to be quite popular in India, as it is an oral medication, the weight loss achieved with the oral Semaglutide is not as powerful as with its injectable form, Ozempic or Wegovy,” he said.

Dramatic results

Dr BM Makkar, senior diabetologist and president of the Research Society for Study of Diabetes in India said that Ozempic, an injectable drug indicated once a week for managing diabetes, has been shown to induce significant weight loss besides controlling blood sugar in the US and Europe.

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Wegovy (Semaglutide 2.4 mg), on the other hand, which has been tested in large clinical trials, has been found very effective in achieving weight reduction to the tune of 17 percent.

“Earlier, we didn't have any medication contributing to a weight loss of more than 5-7 percent,” Makkar said. “So this is a breakthrough that we finally have options to reduce weight through medical management”.

Availability in India

When contacted a spokesperson for Novo Nordisk in India said that Semaglutide in oral form (available as a once-daily tablet) for treating type 2 diabetes is available in India.

In general, people in the country tend to prefer tablets over injectables and oral Semaglutide provides the benefits of the GLP-1 RA therapy with the convenience of a tablet, said the spokesperson.

“Clinical trials show that it achieved unprecedented blood glucose control (HbA1c reduction of up to 1.5%), unsurpassed weight loss (up to 5 kg), cardiovascular safety, reduction in cardio-metabolic risk factors with low risk of hypoglycaemia,” the company added.

While currently, Novo Nordisk is running phase 3 trials globally for oral Semaglutide for the treatment of obesity as well, the drug in injection form is currently on hold in India and the firm will evaluate the need in the coming times should there be a case for launch.

Mohan, who is chairman of Dr Mohan's Diabetes Specialities Centre in Chennai, pointed out that Rybelsus, though expensive, has proven to be a boon for controlling diabetes and losing some kilos in those who can afford it.

“Apart from this, it also has some cardiovascular benefits as well,” he said.

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Tread cautiously

Dr Karishma Matai, diabetologist with Sterling Hospitals in Vadodara, said that Ozempic is a beneficial medicine for diabetic people that aid in the management of their chronic excessive weight problem.

However, following a social media trend may be risky because they are done to get views and are not medically appropriate, she warned.

“Ozempic should not be used solely to lose weight because it has serious negative effects,” Matai said. “Those who use this drug without visiting a doctor may experience nausea and vomiting. Health professionals have expressed their concerns about rising demand and disruptions in supply to those who genuinely require it.”