Lilly, Novo, Pfizer are looking at new weight loss drugs

Drugmakers only have months to launch GLP-1 pills and are looking at big changes in how patients pay for weight loss drugs.

However, they are already explaining their views on the future of obesity drugs.

At the Scientific Conferences of the American Diabetes Association in New Orleans last week, drug makers pitched doctors and investors to the idea of ​​new shots and pills, drugs that can be taken regularly, and new treatments beyond GLP-1 that may have fewer side effects. Attendees debated where all these new treatments could fit in, especially since Eli Lilly currently dominates the imaging market and attendees were impressed with data from its triple-acting experimental retatrutide that produced weight loss that has yet to be seen.

Lilly and the rival Novo Nordisk they showed off the new GLP-1 tablets they each launched earlier this year. Both companies have made the case that oral options are bringing more people to the weight loss drug market, with Novo suggesting that prescriptions for the Wegovy pill reached more than 3 million in just five months of launch.

Behind the two market leaders is a wave of new entrants hoping to break into the big market in the coming years.

Medicinal Properties again AstraZeneca each shared mid-stage data on their GLP-1 tablets. If those oral drugs pass Phase 3 trials, they could come to market around 2029, three years after Lilly, which launched its small-molecule pill Foundayo earlier this year (the Wegovy pill is an oral peptide).

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

“Who wins at the end of the day competitively? The patients, and that’s really what this is about,” Stevens said, adding that being a second small molecule drug will be important. “We’re pushing hard to get into that second position behind orforglipron, now Foundayo.”

Pfizer again revealed the mid-stage data in the shooting it received for its 10 billion Metsera acquisition. The drug has shown potential to be given monthly, which Pfizer thinks could be more convenient than the current weekly shots. Another drug maker, Amgentests a different drug that can be given monthly or even quarterly.

Susan Sweeney, Amgen’s senior vice president for obesity and related conditions, said the company sees an advantage in people not needing injections every week and instead thinking about treatments four times a year.

“For someone who has been overweight for a long time, it can be very helpful not to remember your disease,” she said.

Other companies are looking beyond GLP-1 and other hot targets like GIP and glucagon into emerging areas like amylin, another hormone produced in the pancreas that helps people feel full. One company Zealand Pharmawhich presented mid-stage data from a drug called petrelintide that we developed Roche.

The test shot helped people lose about 11% of their body weight — less than the currently available injections Wegovy and Zepbound. But Zealand showed that fewer people taking the drug vomited than those in the placebo group.

“I really believe that there is this amylin [drugs] launch, we can have that, which I described as an iPhone moment, because patients know the information they have on GLP-1s, and if you introduce a new method that gives you better information, people will line up to get access to that new weight loss drug rather than staying on more difficult drugs,” said Zeeland CEO Adam Steensberg.

Like other potential entrants, it will be years before Zealand’s drug is available. Market leader Lilly is developing its own amylin analogue called eloralintide which is already in phase 3 trials.

At this year’s ADA, Lilly also presented Phase 3 results from the triple agonist retatrutide. That drug uses GLP-1, GIP and glucagon receptors, producing significant weight loss.

On average, people lose an average of 28% of their body weight when they take retatrutide and stay on it as determined in the study. Lilly CEO Dave Ricks sees the drug as a way to help people with a body mass index of more than 40, or the highest obesity category, achieve a healthy weight, something that’s impossible if they have a moderate response to Lilly’s current Zepbound.

“We’ve shown what’s possible, what makes sense: About half of people lose more than 30% of their body weight,” says Ricks. “So if you start at a higher level, you can get to a healthier state, which is everybody’s goal, I think.”

Investors are now trying to determine whether the market will remain a duopoly between Lilly and Novo or whether potential entrants will become significant players. Newcomers point out that there are about 2.5 billion people in the world who are considered obese, 890 million are considered obese according to the statistics of the World Health Organization.

“The big question is not volume, it’s really pricing,” said Goldman Sachs analyst Asad Haider. “Where does that end?”

Lilly and Novo have cut the price of their weight-loss products over the past year as they compete with and consolidate pharmacies that sell less expensive versions of their drugs. Both Lilly and Novo are also trying to improve health insurance coverage of GLP-1 weight loss drugs.

In a few weeks, millions of seniors on Medicare will be able to get prescription drugs for $50 a month out of pocket.

Novo Nordisk CEO Mike Doustdar thinks that in the coming years obesity will look like mental health, when people call it one condition.

“Today that is depression, bipolar, schizophrenia, in many, many different cases with very different, different medications, and patient support. We look at obesity in that way,” he said.

With so many drugs on the way, the future of obesity treatment, and who uses which type of treatment, could look very different. At least that’s what drug manufacturers are trying to get a large share of the market’s hope.