GLP-1
A class of anti-diabetes and anti-obesity molecules whose mass uptake can shift a country's mortality and upend longevity assumptions.
The Canadian semaglutide patent lapsed in 2020 over an unpaid maintenance fee, which clears the way for generics in Canada from 2026 and weighs on the size of a national longevity shock. GLP-1 receptor agonists, approved as early as 2005 for diabetes and later extended to weight loss and cardiovascular risk, have moved out of specialist therapeutics and into public health. One major reinsurer puts the possible cut in cumulative US mortality by 2045 at 6.4% in its optimistic scenario and 2.3% in its pessimistic one. A factor of three between the bounds. The gap owes less to model imprecision than to the indeterminacy of the variable that drives everything, namely price, reimbursement and adherence. For the life actuary, mortality stops being a demographic trend to extrapolate. It becomes a decision variable, hanging on a patent and a public budget trade-off, and a table calibrated before GLP-1 can be thrown off by a reimbursement decision.
The SELECT trial, published in the New England Journal of Medicine in November 2023, followed 17,604 overweight or obese adults with established cardiovascular disease and no diabetes: on semaglutide 2.4 mg, 6.5% had a major adverse cardiovascular event against 8.0% on placebo, a 20% reduction. That is the figure that brings the molecule into mortality tables. The Canadian patent, lapsed in 2020 over an unpaid maintenance fee, then weighs on the size of the shock: generics can arrive from 2026.
- SELECT trial, New England Journal of Medicine, November 2023 (17,604 patients, primary endpoint 6.5% versus 8.0%, hazard ratio 0.80), as reported by The Pharmaceutical Journal and MDedge
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