周末医疗脉搏：GLP-1s - 美容炒作与医学进展

EXHIBIT 3: Oprah on Shame,Blame, and the Weight-LossRevolutionOprahDSource: https://www.oprahdaily.com/stateofweight/ EXHIBIT 2: "Like Cocaine Bear,but Santa and Ozempic!"Musk added in a separatetweetCenMakoeSource: https://www.independent.co.uk/news/world/americas/us-politics/elon-musk-weight-loss-mounjaro-ozempic-b2670559.htmlThe rise of compounding pharmacies: regulatory gray zonesand explosive demandWith soaring GLP-1 demand and persistent shortages frommanufacturers, compounding pharmacies have emerged as critical,if controversial, players in meeting supply gaps."Economic compounding" has surged in response to GLP-1shortages,withsemaglutidebeingreformulatedby compoundersto bypass branded supply constraints. In 2021 alone, 41 newcritical shortages were reported in the U.S., reinforcing the s@tor'srole as a parallel supply chain. These facilities operate under dualregulatory standards 503A (traditional compounders) and 503B(FDA-registered outsourcing facilities) often ndigating a gray zone.However, since the end of May, cginpounding pharmacies areno longer allowed to sell their微oduts (Wegovy is no longer onthe FDA drug shortage list as Novo can supply the demand). As areminder, the company estimates that these products account for30% of the US obesity market and that 80% of the molecules aresemaglutide, so Novo is the most impacted obesity player.From 30 June, Novo will offer the first month of Wegovy(semaglutide,GLP-1 inobesity)at$199,thensubsequentmonthsat $499 for patients that have to pay for the treatment from theirown pockets (available via NovoCare Pharmacy). This is a new wayto challenge the compounding pharmacies. However, we don'tknow the level of stocking, and the compounding pharmaciesare trying to circumvent the law by selling lower dose versionsor by adding vitamins to their semaglutide copies (e.g. vitaminB6, arguing that this should lower the gastrointestinal sideeffects). Novo plans to intensify legal actions to fight compoundingpharmaciesandthuspushtheseproductsoutoftheUSmarket.To date, Novo has filed nearly 120 lawsuits across 34 states.According to Novo, over 50% of the semaglutide supply isEUROPEAN BIOPHARMACEUTICALS accounted for by Chinese products that are not even approved inChina.Since the end of May, Novo has launched a new digital advertisingcampaign, based on the success of the "Check before you inject"advertisement, to convince patients to "Choose the real thing"So, in other words, the campaign will emphasize the importanceof using FDA-approved treatments and avoiding compounded orcounterfeit drugs.EXHIBIT 4: Regulatory gray zones or illegal drugs?himsCompoundedSemaglutidea/2mL(2.5mg/ml)Source: BernsteinThe “"Birkin Bag" narrative: GLP-1s as a luxury good?GLP-1s have been likened to luxury consumer goods, not only dueto their pricing (~$1,o00/month) but also due to the social signalingassociated with their use (Exhibit 5).EXHIBIT 5: Wegovy annual treatment price compared toluxurybags10,00wegovyE4m.e6,00HSource: Bernstein analysisBut unlike luxury goods, GLP-1s suffer from poor long-termadherence (only 24-30% of patients remain on treatment at 24months), lack durable brand loyalty, and face substantial switchingrisk once more tolerable or convenient alternatives emerge (e.g.orals, dual-agonists).BERNSTEIN SOCIETE CENERALE CROUP Thus, while the comparison to luxury goods captures theaspirational aura of GLP-1 use, it obfuscates the fact that thesearemedical interventionsthataremoreappropriateforseveresufferers and have high discontinuation rates due to unpleasant(butsometimessevere,althoughrare)sideeffectsPERCEPTION VS SCIENCEPublic misunderstanding: “Eat, Inject, Repeat"Mainstreamand socialmediahavefosteredan oversimplifiedviewof GLP-1s.The Economist's headline"Eat, Inject, Repeat"(Exhibit6) encapsulates this, implying effortless, pharmacologicallydriven weight control. However,clinical datafrom the STEP andSURMOUNT programs challenge this narrative:: ~66% of lost weight is regained within one year after GLP-1discontinuation (STEP-1 extension)..CardiovascularbenefitsobservedintrialslikeSELECTreversepost-cessation.~1/3oftotalweightlostduringtreatmentisleanmusclemass,which is harder to regain.This highlights a critical misunderstanding: GLP-1s are not passiveweight-loss tools. They require structured medical oversight andmust be embedded within a behavioral framework (nutrition,exercise,psychologicalsupport).EXHIBIT 6: Easy come, easy go?A weekly shotto lose weightTheEconomistrSource: The EconomistShort-term use for weight loss: the illusion of controlThe short-term, appearance-driven use of GLP-1s creates a falsesense of mastery overweightregulation.Discontinuation oftenresults in rapid fat regain, typically in a shorter time than the originalweight loss period.EUROPEAN BIOPHARMACEUTICALS Mechanistically, this is due to:Suppression of endogenous GLP-1 secretion. Rebound in hunger signaling: Disruption of gut microbiota affecting satiety and metabolismThe SELECT trial found