Will Indians get blockbuster weight-loss drugs at cost of cheaper insulin?

Will Indians get blockbuster weight-loss drugs at cost of cheaper insulin?

That’s what some are wondering after Novo Nordisk has said it is discontinuing selling its insulin brand in India.

The decision from the Danish company could shake up the insulin market, say experts.

It comes as the firm has decided to promote its newer blockbuster drugs such as Ozempic and Wegovy  around the world due to their higher profitability.

But what happened? What do we know?

Let’s take a closer look:

What happened?

The Times of India reported that multinational Novo Nordisk will stop selling its most popular insulin brand, Human Mixtard, in pens in India.

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Human Mixtard is the country’s top-selling insulin brand.

It is valued at Rs 800 crore in India.

According to the report, the development could affect its top brands in the Rs 5,000 crore insulin market including Actrapid, Insulatard, Insulin Detemir and Levemir and Xultophy.

These are sold primarily in the format of pre-filled disposable pen and cartridges (Penfill and FlexPen).

Documents accessed by the newspaper showed that the company told marketing partner Abbott India the products would be withdrawn after current stocks are finished.

The process could take around six months.

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However, the company plans to continue selling Human Mixtard, Actrapid and Insulatard in vials.

Novo Nordisk is gradually ending production of human insulin pens, the drugmaker said.

The company declined to comment on the timeline.

“Globally (human insulin pens) will be phased out over time and human insulin will be available only in vials,” a spokesperson said.

Why is the company doing this?

As per the report, the company is doing so as part of a wider strategy to prioritise newer, patented diabetes and weight loss therapies such as Ozempic and Wegovy.

Booming sales of the Danish drugmaker’s new obesity and diabetes medicines, delivered in injection pens, have propelled it to become Europe’s most valuable company by market value, at about $572 billion.

The company is also planning to bring these drugs to India in 2025.

As per Outlook, Novo Nordisk wants to loss obesity drug Wegovy in India in the next few months.

Novo’s decision comes after rival Eli Lilly got the greenlight from Drug Controller General of India (DCGI) to launch Mounjaro in India.

Novo Nordisk has said that the pens it uses for human insulin are not the same as those for its GLP-1 agonists Wegovy - a weight-loss treatment - and Ozempic, a diabetes drug.

But the delivery devices are similar, and the company said last year that broader use of Wegovy could lead, longer-term, to fewer people with type 2 diabetes needing to take insulin, a medicine Novo Nordisk has made for a century.

However, the development could pose potential problems for patients.

In wealthy nations like the United States, the majority of people with diabetes now use modern or analogue insulin, not human insulin, because the former enables better blood sugar control.

In low-and-middle-income countries, human insulin is more commonly used than analogue insulin, which is more expensive and harder to make.

As per The Guardian, despite the inventors of insulin selling it for $1 to ensure its availability, today just three companies make over 90 per cent of insulin.

Those suffering from diabetes also say they much prefer using disposable pens to glass vials and syringes.

Pens are easier and more precise to use than syringes for injecting insulin.

The newspaper quoted  a survey by Médecins Sans Frontières (MSF) and T1International as finding that 82 per cent of people with type 1 diabetes preferred to use pens rather than syringes and vials.

MSF and T1 International criticise Novo Nordisk’s focus on manufacturing pens for its new medicines – which are not yet available in poorer nations.

The groups see an emerging double standard in diabetes care: people with diabetes in high-income countries will not suffer from the halting of insulin pen production, because the company is continuing to make analogue insulin pens for those markets.

‘Makes me angry’

Patients in South Africa have already had to switch to vials – and they are not happy.

Lecritia Roberts, 31, from South Africa, told the newspaper, “It makes me angry. They don’t understand how much harder they are making our lives.”

“Why are they making things more convenient for people who want to lose weight over people struggling with a disease?”

“When I was younger it was challenging, I didn’t like injecting. Sometimes I injected it into the floor because I didn’t like having the needle in my arms or thighs. If your break the vial and don’t have any [saved] back, you basically don’t have any insulin unless you buy it, but people in rural areas can’t afford it.”

Some diabetes patients in the US have this year pushed back against the company’s decision to stop selling its long-acting insulin Levemir, which is an analogue insulin.

They say the move has left them struggling to switch treatments.

On Thursday, several hundred people gathered outside Novo Nordisk’s office in Johannesburg to protest the company’s discontinuation of human insulin pens, according to MSF, which helped organise the demonstration.

Candice Sehoma, advocacy adviser for MSF’s Access Campaign said, “While the corporation continues to profit immensely by supplying newer, more expensive insulin and semaglutide pens ( Ozempic and Wegovy) to wealthier nations, its decision to withdraw human insulin pens may push people with diabetes in resource-limited settings, who rely on insulin for survival, to revert to using vials and syringes, which virtually nobody uses any more in high-income countries.”

“The profiteering on a lifesaving medicine that has been available for more than a century must stop now,” Sehoma added.

“We appreciate the impact our portfolio decisions will have on patients in South Africa and understand the frustration this may cause,” Novo Nordisk said in a statement.

It added that it is in talks South African health authorities to ensure that diabetes patients continue to have access to treatment.

With inputs from agencies