Asia-Pacific (APAC) medical and pharmaceutical fields have increased their presence globally in recent years. Such exponential growth has made the region one of the major players in the world, with various global pharmaceutical companies targeting the area as their future growth engine. Against this backdrop, Korea Biomedical Review has decided to hear the opinions of the top management of multinational pharmaceutical companies in this part of the world and learn about their goals and plans -- Ed.

Glucagon-like peptide-1 (GLP-1) is receiving recognition for its considerable clinical effects on weight loss and diabetes.

GLP-1 analog acts on the pancreas to increase insulin secretion and decrease glucagon secretion, showing a hypoglycemic effect, delaying the passage of food in the stomach and controlling blood sugar.

GLP-1 analog has also confirmed the safety profile of the risk of cardiovascular disease, one of the major complications or comorbidities of diabetes, through clinical studies.

For this reason, recent global guidelines including that of Korea recommend the early selection of GLP-1 analog in consideration of the risk of cardiovascular complications in type 2 diabetes patients.

Recently, the GLP-1 is attracting attention as an obesity treatment, too.

This trend started when Novo Nordisk's Saxenda (ingredient: Liraglutide) appeared in the market. Novo Nordisk launched the product in 2015 as an obesity treatment by increasing the dose of Victoza, which is used to treat diabetes.

The launch of Saxenda caused a sensation in the obesity treatment market because psychotropic drugs had dominated the market.

Against this backdrop, Korea Biomedical Review met with Dr. Gurudutt Nayak, Novo Nordisk’s medical director for the GLP-1 diabetes portfolio in the Asia-Pacific region, to learn about GLP-1 in detail.

Question: Please give me a brief introduction of who you are and what you do.

Answer: I am the medical director for the GLP-1 diabetes portfolio within the Asia Pacific region.

Novo Nordisk's Asia Pacific region includes seven key countries and Southeast Asia, and it's an important key market for the company.

In terms of what I do, my role is within the medical affairs department, and I work with colleagues in Korea and also other countries and support them in their medical strategy building as well as pre-and post-launch of a product.

Q: What is the global trend in GLP-1 treatment?

A: GLP-1 therapies are fairly new within type 2 diabetes treatment, with the first GLP-1 treatment coming out in 2006.

However, after the first treatment, there have been introductions of newer molecules.

Since 2014, there has been a steady shift towards a once-weekly treatment mainly to increase patient convenience.

The first was Trulicity, a product developed by Eli Lilly, soon followed by Novo Nordisk's Ozempic.

In addition to the patient convenience, these once-weekly treatments had higher potency and efficacy, such as better glucose-lowering effect and weight reduction.

However, in Korea, there is currently only one GLP-1 in the market, which is Trulicity.

While Novo Nordisk received approval for Ozempic and Rybelsus, the world's first oral GLP-1 analog formulation, earlier this year in Korea, the company has not yet launched the product in the country.

The Korean offshoot and APAC office are working very hard with the related government agencies to launch the two products, and we will be launching both or one of them soon in the Korean market.

Q: Despite the superior efficacy of GLP-1, a lot of patients in APAC and Korea, compared to the West, are hesitant to receive GLP-1 treatment because of their dislike or fear of the needle injection method. Is Novo Nordisk doing anything to address this issue?

A: Novo Nordisk does quite a lot in terms of education.

For the company, the primary customers are always physicians, as the company cannot go to the patients directly, except for the U.S. market.

So in the broad sense of education, we do quite a lot of activities to highlight the exact role of GLP-1 in the APAC region because the role of GLP-1 is not well understood.

Novo Nordisk lays out all the detail from discovering the candidate to develop. So, it's not just saying, okay, this is an injection that is good, but the company takes its time explaining where it comes from, what are the effects, the convenience, and what are the side effects.

When it comes to patients, Novo Nordisk also agrees that patients still prefer oral pills instead of injectables.

The company data shows that roughly seven out of ten patients still prefer a pill.

So, there is a lot of education that's needed for the patients as well.

However, when looking at our device, the needle is tiny and the width is also very thin.

Therefore, the sensation of injection is almost non-existent, and it is completely different from taking a blood test with long needles, and the company is trying to demonstrate this fact through various channels.

Novo Nordisk also provides patient support programs, which can be three to six months long depending on local regulations.

During the support program, patients will receive information about the product weekly. The program also provides dietary or exercise counseling.

Q: GLP-1 has had a huge impact on the obesity market. What are your opinions on how the GLP-1 has changed the market, and how will it further affect the obesity treatment?

A: the obesity market is not as structured as type 2 diabetes. Obesity is still seen as a biased area. The global community is not talking about weight in a positive way.

So, we are first trying to change that through a positive reinforced message.

Since we launched Saxenda in 2015, the company has always focused on building a positive narrative. For example, we try to identify the physicians managing obesity and explain to them that losing weight is not a short-term goal but a long-term effort.

Q: Due to Novo Nordisk's success in the obesity market, the company faces a lot of competition from other companies including Eli Lilly. What does the company think about such competition?

A: Novo Nordisk thinks that it is great that other companies are also coming into this field, as there will be more communication around obesity and more understanding of the subject.

I believe that none of the companies entering the obesity market is doing so to make a quick buck.

That is why Novo Nordisk is continuing to invest in its obesity pipeline as well.

Q: Novo Nordisk is currently facing a global supply shortage issue regarding its new GLP-1 products, such as Wegovy and Ozempic. Can this delay the drug launch schedules in APAC region? Also, what is the launch schedule for the two treatments in APAC?

A: It's public knowledge that Novo Nordisk has been facing some supply issues due to the high demand for both products.

According to our third quarter results, released last Wednesday, at least for the U.S., where the two products are already marketed, we will resolve the supply issue by the end of this year.

However, the supply issue in the U.S. delayed all other launches, not only in Korea but in other countries as well.

Still, Novo Nordisk is confident that it will be able to launch Wegovy in Korea.