Obesity: “The Wegovy is revolutionizing the lives of patients, and it will be more effective!” says Professor Antoine Avignon

L’obésité est un problème majeur de santé publique. Midi Libre – JEAN MICHEL MART

Is Wegovy, a new treatment for obesity, as effective as imagined ? For Antoine Avignon, head of the nutrition-diabetes team at the University Hospital of Montpellier, the answer is positive. The doctor is all the more optimistic than others. promising drug therapies will soon arrive on the market, while the need for care continues to increase: nearly one in two people is overweight or obese in France, according to the ;rsquo;Oféo study published Thursday June 20 by the National League against Obesity.

Antoine Avignon, endocrinologist at Montpellier University Hospital, is one of the leaders of the Specialized Obesity Center (CSO) Occitanie Est which is organizing its 10th territorial day, free and upon registration, on June 28 at the Hotel city ​​center of Montpellier, intended for health professionals.

Professor Antoine Avignon, endocrinologist, is head of the nutrition-diabetes team at Montpellier University Hospital. M.L.

Does Wegovy, a new drug against obesity, keep all its promises ?

When it comes to treatments for obesity, we often hear a lot of negative things. There, I believe that we are in a rupture, it is a revolution in the support of people who live with obesity.

Obesity must be considered as a disease, but it is a discredited, stigmatized disease, and for which there was no drug treatment until now.

There, we have effective treatments, with good tolerance, which have demonstrated their beneficial effect on cardiovascular complications, on survival… For me, it's a real revolution and I really want to fight while there is tension over these drugs, which are difficult to obtain. These are the same as those used in diabetes, but in higher doses.

That’s exactly it?

Yes, Wegovy is a semaglutide, used against type 2 diabetes under the trade name Ozempic.

Except that for diabetes, the dose is one milligram, and in obesity it is 2.4 milligrams. It’s the same molecule. So, indeed, there is a rush in countries like the United States, and in France too. But in France, it is not available.

Not even if we are in a protocol in an expert center for obesity ?

Today, it is no longer available at all.

Due to the breakdown of certain drug chains or for administrative reasons ?

We had him in Montpellier for a year as part of what we call an early access procedure. That is to say that even if the laboratories and Health Insurance did not agree on the modalities of access, nevertheless, it was available in specialized centers thanks to to an amendment.

Due to international tensions over these products, early access was stopped, not by Health Insurance but by the laboratory, which preferred to supply other countries .

"We can't abandon them like that"

Your patients tested it ?

We had 413 patients who were prescribed it. For a majority of them, it was a revolution. There are people who have regained mobility, who have found themselves in their jobs…hellip; I'm thinking of a gentleman who lost 50 kg, who shows new impetus in his professional life, and there are many people like that. The majority of patients are transformed.

These people, fortunately, will be able to continue treatment until the end of September 2024. We hope that by then, the laboratory and Health Insurance will find an agreement. We can't abandon them like that.

It's like having a treatment for diabetes or asthma, and then suddenly deciding to stop treating patients in the most effective way possible. All this shows how much obesity is discredited.

How does Wegovy work ?

People with obesity often have a lot of trouble feeling hungry and full. This medication makes them feel less hungry and helps them feel full. It also works against the effects of so-called emotional eating.

It's the perfect medicine, it has no side effects?

I didn't say it was perfect. It's very useful.

The majority of side effects are minor, nausea and vomiting for 8% to 10% of people, and there is a very very rare risk of pancreatitis.

This is the only drug of interest today?

Not at all, there will be more effective! There is already Tirzépatide in the United States, which will be sold in France under the name Mounjaro. It is a molecule which has the same action as Wegovy, but not in the same way: Wegovy acts as a hormone of the digestive tract while Tirzepatide acts as two of its hormones, with greater effectiveness .

And there are even more effective molecules being tested, retatrutide for example, which can achieve 25% weight loss. With Wegovy, the average weight loss is – 16% to – 17%. With the Tirzépatide Mounjaro, we go beyond the – 20%.

"This is not the end of bariatric surgery"

This is the first time that so many hopes are allowed ?

Yes, we really have a breakthrough in the treatment of obesity. There have already been interesting molecules, but which end up having serious side effects, either on the cardiovascular level or on depression… The reassuring side is that this time we start with molecules that have been used to treat diabetes.

And if we come back to Wegovy, there are studies in the biggest journals, such as the "New England Journal of medicine", which show the reduction in cardiovascular events.

So that’s the end of obesity surgery?

No, because there can be complementarity. But there are failures. We have published a study which shows that the Wegovy works as well in patients who have failed bariatric surgery as in those who have not had surgery.

There will also be non-responders to drug treatment, and people who will need surgery after drug treatment. This is not the end of bariatric surgery, it is the question of positioning therapies that are more complementary than rivals.

But we remain in the curative sector.

More than ever, we must continue the interdisciplinary management of obesity, with dieticians, possibly adapted sport… to increase the chance of healing ?

Of course. We have already noticed that people who have made efforts to maintain a balanced diet lose more weight than those who take the medication without any effort. To benefit from the treatment, candidates had to agree to enter into a multidisciplinary treatment protocol. They had to have advice. But we did not condition access to treatment on the application of measures.

The message that you recalled in the preamble, obesity is a disease, has still not gotten through?

No, I don't think so, there's still a big stigma.

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