Australia is set to get a Wegovy pill. How does it compare with weight‑loss injections?

Australia is set to receive a Wegovy tablet, a novel weight-loss option for individuals struggling with obesity or overweight conditions accompanied by related health issues. Until now, the most common approach to this class of medication, semaglutide (Wegovy or Ozempic) and tirzepatide (Mounjaro), required weekly injections. Now, a daily tablet offers an alternative for those who prefer not to or cannot inject themselves.

Wegovy contains semaglutide, a medicine that mimics the action of the naturally occurring hormone glucagon-like peptide-1 (GLP-1). This hormone regulates blood sugar, appetite, and digestion. The tablets are available in four strengths: 1.5mg, 4mg, 9mg, and 25mg.

The tablets work by acting on the brain and digestive system, reducing hunger, increasing feelings of fullness, and slowing the rate at which food leaves the stomach. This helps individuals feel satisfied with smaller meals and decreases their hunger. The tablets are intended for adults with obesity or overweight conditions with other weight-related health issues. They may also be prescribed to a subset of patients with heart disease to reduce their risk of serious heart problems.

When compared to the injections, the tablet must be taken daily with an empty stomach and a small amount of water, waiting 30 minutes before consuming anything else. The injection, on the other hand, can be administered weekly, with or without food. Both formats produce similar gastrointestinal effects and result in comparable weight loss. However, the tablet's effectiveness hinges on patients remembering to take it daily and avoiding food or drinks for half an hour post-dose, unlike the once-weekly injection.

Potential side effects include nausea, vomiting, diarrhoea, indigestion, constipation, kidney injury, pancreatitis, and gallbladder problems. Higher doses intensify these side effects. It is crucial to remember that doubling the dose will not hasten results and may cause harm. Regular doctor visits, however, may lack proper screening for eating disorders, body image concerns, or other psychological issues, which could lead to adverse outcomes for patients.

Although the tablet may be easier for individuals who dislike injections or face difficulties with them, it could also reduce the risk of injection-related injuries. Australia's TGA approval doesn’t mean Wegovy tablets will be readily available. The TGA will need to complete a final review of packaging, production, and retail pricing.

Novo Nordisk, the manufacturer, aims to have the tablets on Australian shelves by the end of the year. However, it is essential to note that Wegovy is not subsidized through the Pharmaceutical Benefits Scheme (PBS) for weight management, so patients should expect to pay the full price. Current out-of-pocket costs are likely to resemble those of the weekly injection, which range from A$250–$450 a month.

It is vital to remember that Wegovy tablets should not be used alone but in conjunction with a reduced-calorie diet and increased physical activity. The TGA has prescribed the medication to be used alongside lifestyle changes, including nutritious food and weight training, to prevent muscle loss. This "lifestyle prescribing" approach is critical, as rapid weight loss can result in the loss of lean muscle mass rather than just body fat. Additionally, stopping Wegovy without making lifestyle changes may result in weight regain.