Lilly, Novo and Pfizer seek new weight loss drugs

Drug makers have only been introducing GLP-1 pills for a few months and are undergoing big changes to the way patients pay for weight-loss drugs.

Still, they are already outlining their visions for the future of anti-obesity drugs.

At the American Diabetes Association Scientific Sessions in New Orleans last week, drugmakers pitched doctors and investors on the idea of ​​new shots and pills, drugs that can be taken less frequently and new treatments beyond GLP-1 that could have fewer side effects. Attendees debated where all of these new treatments might fit, especially as Eli Lilly currently dominates the injection market and impressed attendees with data from its experimental triple-action drug retatrutide that produced the largest weight loss seen yet.

lily and rival Nordisk showed off the new GLP-1 pills they introduced earlier this year. Both companies argued that oral options are bringing more people to the weight-loss drug market, with Novo touting that prescriptions for its Wegovy pill reached more than 3 million just five months after launch.

Behind the two market leaders is a wave of new entrants hoping to enter the mass market in the coming years.

Structural therapeutics and AstraZeneca each shared data from the mid-stage of their respective GLP-1 pills. If those oral drugs are successful in Phase 3 trials, they would likely hit the market around 2029, three years after Lilly, which introduced its small-molecule pill Foundayo earlier this year (the Wegovy pill is an oral peptide).

Structure Therapeutics CEO Ray Stevens believes there will still be plenty of room in the market by then.

“Who wins at the end of the day with the competition? The patients, and that's really what this is all about,” Stevens said, adding that being the second small molecule drug will be important. “We are trying very hard to get to second position behind orforglipron, now Foundayo.”

Pfizer also disclosed interim data from an opportunity it gained through its $10 billion acquisition of Metsera. The drug showed the potential to be administered monthly, which Pfizer believes would be more convenient than the current weekly injections. Another drug manufacturer, amgenYou are trying a different medication that could be given monthly or even quarterly.

Susan Sweeney, executive vice president of obesity and related conditions at Amgen, said the company sees an advantage in people not needing to get a weekly shot and instead thinking about treatment as few as four times a year.

“For someone who has lived with obesity for a long time, it can be a great advantage not to remember their illness,” he said.

Some companies are looking beyond GLP-1 and other hot targets like GIP and glucagon to emerging areas like amylin, another hormone produced in the pancreas that helps people feel full. a company is Pharmaceutical Zeelandwhich presented mid-stage data for a drug called petrelintide it is developing with Roche.

The experimental injection helped people lose almost 11% of their body weight, less than the currently available injections Wegovy and Zepbound. But Zealand touted that fewer people taking the drug vomited than those in the placebo group.

“I really believe that when these amylin [drugs] launch, we can have that, what I've described as an iPhone moment, because patients are very aware of the experience they have with GLP-1, and once a new modality is launched that gives them a better experience, people will line up to have access to that new weight loss drug instead of continuing to take the more cumbersome medications,” said Adam Steensberg, CEO of Zeeland.

Like other potential new entrants, it will be years before Zeeland's drug is available. Market leader Lilly is developing its own amylin analog called eloralintide that is already in Phase 3 trials.

At this year's ADA, Lilly also presented Phase 3 results for its triple agonist retatrutide. This drug activates GLP-1, GIP and glucagon receptors, producing spectacular weight loss.

At the highest dose, people lost an average of 28% of their body weight when taking retatrutide and continued taking it as prescribed in the trial. Lilly CEO Dave Ricks sees the drug as a way to help people with a body mass index above 40, or the highest classification of obesity, reach a healthy weight, something that isn't possible if they have an average response to Lilly's current shot, Zepbound.

“We show what is possible, which is significant: almost half of people lose more than 30% of their body weight,” Ricks said. “So if you start at a higher level, you can really get to a healthier state, which is everyone's goal, I think.”

Investors are now trying to determine whether the market will remain a duopoly between Lilly and Novo or whether potential new entrants will become major players. The newcomers point out that, according to World Health Organization statistics, around 2.5 billion people in the world are overweight and 890 million are obese.

“The big question is not volume, but really price,” said Goldman Sachs analyst Asad Haider. “Where does that end?”

Lilly and Novo have reduced the price of their weight-loss shots over the past year as they compete against each other and against pharmacies that sell less expensive imitations of their drugs. Both Lilly and Novo are also trying to improve health insurance coverage of GLP-1 weight-loss drugs.

In just a few weeks, millions of seniors on Medicare will be able to access medications for $50 a month out of pocket.

Novo Nordisk CEO Mike Doustdar believes that in the coming years Obesity will be seen as mental health once was, when people labeled it as a condition.

“Today that encompasses depression, bipolar disorder, schizophrenia and many, many different problems with very different and different medications and patient support. We view obesity that way,” he said.

With so many drugs in the pipeline, the future of obesity treatment and who uses which treatment could be very different. At least that's what drugmakers trying to gain a bigger share of the market hope.