Summary of communications regarding off-label use of anti-obesity medications

Comments from Dr. Yoshihiko Suzuki (HDC Atlas Clinic)

Recently, strict policies have been announced at the medical society level regarding off-label prescriptions of Wegovy (semaglutide) and Zepbound (tirzepatide), and there are concerns that doctors who prescribe outside the scope of insurance coverage may be subject to expulsion from the medical society.

Main arguments: It is becoming difficult to secure profits through insured medical treatment alone, and doctors' working environments and declining motivation are becoming problems. Private medical treatment is a valuable opportunity to utilize a doctor's expertise and provide a variety of treatment options, and sanctions such as revoking specialist qualifications for off-label use could lead to excellent diabetologists leaving the society and retiring early. Tirzepatide has a 95% or higher success rate in preventing the onset of diabetes, and diabetes prevention is the society's mission, so preventing the use of effective measures is an abdication of responsibility. If the status quo continues, the number of cosmetic doctors who are unfamiliar with these drugs will increase and increase profits, while the number of knowledgeable diabetologists will decrease, leading to a decline in clinical quality and the collapse of diabetes clinics.

Answer from the Japan Diabetes Society

The Society responded as follows:

For people with type 2 diabetes, obesity, and risk of cardiovascular or nephropathy, Ozempic Manjaro can be used regardless of the Optimal Use Guidelines (OUG).

Although we have warned members and specialists about the use of Manjaro and Ozempic in people without diabetes, we are not considering measures to expel members who prescribe outside the scope of insurance coverage. Regarding the use of Zepbound and Ugovi in obese people without diabetes who do not meet the OUG criteria or who do not visit an OUG-compliant facility, since they are not antidiabetic drugs, we are not in a position to warn members, but we cannot recommend their use. Regarding the expansion of insurance coverage to mildly obese people who are thought to be at high cardiometabolic risk and who are not currently covered by insurance, and the review of OUG, we need to work with companies to conduct research.

The environment is not one that is acceptable for the use of tirzepatide and semaglutide for cosmetic purposes. In particular, online-only medical treatment is completely unacceptable as it is not possible to detect side effects.