'Strict Supervision Needed': Pharmarack's Sheetal Sapale On India's Anti-Obesity Drug Boom

Weight-loss drugs have captured popular interest in India recently, with several celebrities speaking about their own journeys with them. The popularity of these drugs isn’t just restricted to celebrities. Demand for weight loss drugs is zooming in India even as drug giants Eli Lilly and Novo Nordisk are facing off in the market with their respective drugs.

Latest Pharmarack data shows that Eli Lilly's Mounjaro, which was launched in March doubled its sales in June to 87,986 units in comparison to May. Between March and May, Lilly had sold 81,570 Mounjaro units in India.

The main drivers of the overall anti-obesity segment are semaglutide and tirzepatide, which represent about 75% of the anti-obesity market.

Sheetal Sapale, vice president at Pharmarack, said on The Core Report that high sales were because of awareness. “It has already been there globally. That's why people know about the efficacy of the product,” Sapale said.

Semaglutide dominates with about 66% market share. Pharmarack said earlier that drugs like Orlistat restrict fat absorption, while the Indian diet is more carbohydrate-rich.

The newer drugs are focusing on the suppression of appetite, lowering of gut mobility, leading to a longer feeling of fullness in the stomach. “You tend to lose at least 20-30% of your weight in the initial five to six months,” Sapale said.

On the other hand, while anti-obesity drugs do provide the initial momentum needed in the weight loss journey, the diet balance in terms of protein intake and other vital nutrients becomes important while one is on anti-obesity drugs. “If one reads the fine print very well, these drugs do have their list of side effects,” Sapaale said.

Sapale also spoke about why these particular drugs are so popular and the possible long-term challenges that can arise from taking them.

Edited Excerpts:

Are weight-loss drug sales among the fastest you have seen in recent times?

In recent years, after the SGLE-2s and DTP-4s, again, which were in the OED segment, in the anti-diabetes and obesity segment, this is one of the fastest-growing products. And the majority of the time, it happens because the market has been built very well. Awareness is good, and consumption, and it's a global product.

It's not that it's getting launched parallelly in India. It has already been there globally. That's why people know about the efficacy of the product.

And that's why the pickup is very good.

And within the weight loss segment, what are the drugs that are, let's say, growing faster? And what are the other trends that you're seeing within that?

See, in the obesity category, anti-obesity products category, we had Orlistat, which was not a GLP-1 agonist, but it's a molecule which existed for a pretty long time. It's around Rs 100 crore, around Rs 70-80 crore market today. But then it did not show that type of rapid growth.

Besides Orlistat, we have Semaglutide, Dulaglutide, Terzapitide, and Liraglutide, of which Semaglutide, Terzapitide are the “in things” because of their efficacy and a good amount of global exposure. The drugs that were available, Orlistat, which was available earlier, the mode of action was reducing the fat absorption, which the Indian diet is more carb-rich. So it did not show that type of result.

But these products that have come in the market today, the GLP-1 agonist, have two, three modes of action wherein they suppress the feeling of hunger, they reduce the gut motility, because of which you keep on feeling full for a longer period of time. And this has really given that weight loss output, which is quite satisfactory. You tend to lose at least 20-30% of your weight in the initial five to six months.

And that's the reason why these drugs seem to be pretty popular. Also, in terms of consumption, Semaglutide tablets were once a day, every day. The newer pens or wires that are available are just a once-a-week injection. Again, the frequency of dosing is also very convenient for the people.

What would you say are the top brands now, or the top three brands right now?

The top three brands in the entire obesity segment would be the Ribensis tablets, which was launched in January 2022. After that, Monjaro, which was launched four months ago. And the latest in the market is Vigovi, which has been launched, I think, two weeks ago.

These are the top-selling brands in the anti-obesity segment. And these are the ones which are creating those waves in the market today.

The point that you made about the pickup of these drugs being strong because of the global exposure. Is this unusual? Because I'm assuming that we've not really bought drugs because they were popular elsewhere in the world. And really those, we essentially bought drugs because they were prescribed to us, and they were a response to local disease conditions and so on.

There are some diseases or some conditions wherein you need to take a lot of effort from your side and control many of your temptations to get better.

Obesity is one such condition where a major lifestyle modification is needed. And if you remember, it's like even we used to say, if I were to get a pill, which would help me to reduce my weight.

This is something which everybody dreamt of having. That's the reason why. It's an easy way out to lose weight. This is the perception that many people have, though it may not be the best perception to have.

And that's the reason why it has become popular. Now, when SGLT-2s and DPP-4s were launched in the market, it was diabetes getting moved to a higher stage, for which the existing products were not giving that type of efficacy. And that's the reason why the acceptance happened.

Whereas over here, we are not talking about diabetes. We're just talking about weight loss. Even if I may not have diabetes, I will still go to the doctor if I want to lose weight.

At least I have read so many things. Can you prescribe me either of these injections?

While these are supposed to be addressing diabetes and obesity itself leads to so many other comorbidities, I know this is still early days, but do you feel that we could see some impact on other drugs which address other comorbidities arising out of obesity? I know it's a more physician question, but I'm just wondering whether there's any data for this.

There's no data for this as such. But if you see the way these drugs act, they suppress your hunger. And they also reduce your gut mobility.

Now, that itself causes a sort of constipation-related issue. And if it is suppressing some function, which suppresses your feeling of hunger, the moment you are out of these drugs, it will again create a sort of dependence. The dependence on these drugs will increase.

I mean, when I'm talking about dependence, it becomes a sort of addiction. Without that drug, you will again go back to binge eating, probably gain more weight. Or constipation.

Constipation, again, has its own side effects. The food stays in your gut for a longer period of time, probably causing some more infections. Also, the type of diet that you consume.

Because you keep on feeling full, not necessarily you will replenish yourself with the essential nutrients that may be needed. So, those are the complications which will definitely arise over a period of time. And if you have seen the popular celebrities who have been on these injections, you will see their muscle mass.

You can see their skin, loose skin. So, basically, the muscle is not developing. There is also a loss of muscle mass that is happening.

So, these are the consequences which may come up over a period of time. And if one reads the fine print very well, these drugs do have their list of side effects. That's the reason why it's very important that these drugs are taken under strict medical supervision.

And for a time period for which they are required, beyond that time period, it's lifestyle modification and diet.