Next steps for Eli Lilly, Novo Nordisk and Pfizer

The future of the fast-growing obesity drug market is determined by more than just drugs that produce greater weight loss.

Top executives from large and small drug companies told CNBC that the next stage for the field will be defined by a wider range of treatment options and improved access for patients. These were among the themes that emerged during interviews with top executives at the annual JPMorgan Healthcare Conference in San Francisco. Eli Lilly, novo nordisk, pfizer and other pharmaceutical companies.

“This year, we’re really seeing the obesity market move away from one-size-fits-all ideas to different medicines for each patient. We don’t have a crystal ball on how that’s going to resolve itself,” Dan Skovronsky, Eli Lilly’s chief scientific officer, told CNBC in an interview at the conference.

“But I think that by presenting people with options, they will choose for themselves in consultation with their doctors. We want to offer something for everyone,” he continued. “And we’re not done yet.”

Over the next few years, management expects to see an expanded menu of obesity treatments that can be tailored to individual patient needs, from pills and less frequent injections to combination therapies and drugs designed to promote weight loss while preserving muscle mass. Others predict that the direct-to-consumer market will become an even larger part of the market, with hopes that the hurdles that prevent patients from receiving treatment will continue to fall.

Novo Nordisk and Eli Lilly are widely credited with establishing the market through weekly GLP-1 injections for obesity and diabetes, which have grown in popularity in recent years. The next chapter is already taking shape, with Novo launching its first obesity treatment GLP-1 pill earlier this month and Lilly preparing to bring its own oral option to market later this year.

While these companies will play a key role in how the sector evolves, others could also enter the market, from pharmaceutical giant Pfizer to lesser-known startups, both of which could threaten the sales dominance of the two rivals and offer consumers more treatment options.

Although access remains a challenge for many patients, the ability to obtain GLP-1 has improved significantly over the past year. Both Novo and Lilly have lowered the cash price of their shots and in November struck a deal with President Donald Trump to introduce Medicare coverage for obesity drugs for the first time later this year.

More treatment options and broader access could strengthen analysts’ predictions that the weight loss and diabetes drug market could reach a value of nearly $100 billion annually by the end of 2010.

In an interview at the conference, Novo Nordisk CEO Mike Doesder said that between the company and Lilly, about 15 million obese patients are currently taking GLP-1. He added that, together with those who are overweight, there is still a “long way to go” to reach the 110 million people reportedly suffering from the disease.

McKinsey said in a May report that it expects 25 million to 50 million U.S. patients to use GLP-1 by 2030.

Executives say what the future of the sector could look like.

Pills have not yet been proven to be more effective than injections.

Still, management consensus is that oral options have the potential to expand the market and reach entirely new patients. That could include people who are afraid of needles or who might benefit from existing shots but don’t think their symptoms are severe enough to require weekly shots.

In an interview at the conference, Dusdahl said people who travel frequently or who cannot easily refrigerate their injections may also be eligible.

“There’s a lot of consonance with this market expansion story…because there are so many patients who simply aren’t interested in injecting themselves to lose weight,” Dusdahl said.

The “real growth” and adoption of the pill will come from primary care doctors, who write the majority of prescriptions for Americans and generally prefer pills to injections, said CEO Ray Stevens, who is betting on the obesity market. structural therapy.

He said he believes his company’s GLP-1 tablet areniglipron will be the third company to enter the market after Eli Lilly and Novo Nordisk. Structure’s oral drug will enter Phase 3 trials this year.

Taking the pill daily gives patients more flexibility. For example, Stevens said that on days when they need to attend an important meeting, patients can cut their pills in half to reduce side effects.

Lilly’s Skovronsky said the tablets could also serve as a way for patients to “de-escalate treatment” after the injection. In December, the company released data showing that patients who initially received Wigoby or Zepbound injections maintained most of their weight loss after switching to Lilly’s pills.

“They say, ‘I lost weight, I got this, and I can maintain this weight on my own with something less intense,'” Skovronski says.

Structure is also developing an oral drug targeting amylin, a new weight loss treatment that suppresses appetite and reduces food intake by mimicking a hormone co-secreted by the pancreas with insulin. Novo is developing a drug called amicretin that targets both GLP-1 and amylin, potentially promoting weight loss.

Dr. Stevens said combination therapy “is going to be the next step in this field.”

For example, Structure hopes to combine an oral GLP-1 drug with an amylin drug to achieve even greater weight loss than either alone, which he said will likely be “one of the best combinations of the future.” Although it is too early to tell which patients are best suited for the regimen, Stevens said the regimen has the potential to achieve “good tolerability, very good patient experience, and good efficacy.”

He said the company is already working on manufacturing the two ingredients together in one pill, similar to what Novo’s amicletin accomplishes.

However, he said combination therapies are more effective than single products for treating certain obesity-related conditions. It could be like combining GLP-1 with one of the existing treatments for fatty liver disease.

“It feels like we’re starting to see monotherapy winners,” he says. But Stevens said the treatment a patient would receive would be segmented based on other health conditions a person has in addition to obesity, such as fatty liver disease, chronic kidney disease or cardiovascular disease.

Although Lilly’s upcoming pill is oral GLP-1, Skovronsky said the company sees potential in a pill that targets that hormone along with another hormone called GIP, as it is a “preferred formulation.”

This is how tirzepatide, the active ingredient in Lilly’s blockbuster obesity and diabetes injection, works. The drug has proven more effective than semaglutide, the active ingredient in Novo Nordisk’s rival injection, which targets only GLP-1.

Skovronsky said the company is “working hard to develop those drugs” in oral form, but was not prepared to provide details.

Pfizer took over several experimental shots and pills that could be used in combination from obesity biotech company Metsala, which it acquired last year for about $10 billion.

However, Pfizer CEO Albert Bourla said the company is also developing an in-house oral drug that blocks GIP receptors, which could significantly reduce side effects when used in conjunction with GLP-1.

“We have high hopes that this will lead to differentiation,” Bourla said.

A biotechnology Wave life scienceCEO Paul Borno said in a conference interview that he sees the combination as part of a broader strategy.

Wave takes a different approach to weight loss, targeting how your body burns fat rather than suppressing your appetite. The goal is to achieve weight loss comparable to GLP-1 with less frequent dosing, such as once or twice a year rather than weekly, without muscle loss.

The move comes amid increased attention to the quality of weight loss from next-generation obesity drugs, as GLP-1 treatments raise concerns about loss of muscle mass, side effects, and patient attrition.

Wave has an experimental injection that uses RNA technology to lower levels of a protein called activin E, a protein produced in the liver that slows fat burning. Wave believes that by reducing that protein, the drug can promote fat loss, especially harmful visceral fat, while preserving lean muscle mass.

Borno said the company is developing the injection, called WVE-007, as a monotherapy or potential maintenance therapy that patients can switch to after taking GLP-1, significantly reducing the frequency of dosing.

But he also sees an opportunity to “continue to drive margins” by combining the company’s shot with GLP-1.

“When combined with GLP-1, you can double the weight loss,” Borno said, referring to what the company is seeing in preclinical studies.

He said the addition of Wave’s injectable drug to GLP-1 does not make it harder for patients to tolerate the treatment regimen, making the company’s drug an “easy combination” option.

As for who can use Wave’s injection, Borno said it will work for any patient because “this happens to be a target that actually exists in human genetics.”

The future of the industry may also include drugs that can achieve greater weight loss than currently available treatments.

In December, Lilly announced the first late-stage data on an injectable drug called letaltortide. The data showed that at the highest dose, patients who continued treatment achieved more than 28% weight loss over 68 weeks. Lilly will read data from seven other Phase 3 trials of the drug this year.

Referred to as a “triple G” drug, letaltortide works by mimicking not just one or two, but three hunger-regulating hormones: GLP-1, GIP, and glucagon. It appears to have a more powerful effect on a person’s appetite and food satisfaction than other treatments.

Skovronsky said the drug could help patients who need additional weight loss or who have serious health conditions such as arthritis and knee pain in addition to obesity.

Novo Nordisk is racing to catch up. In March, it agreed to pay up to $2 billion for the rights to an early experimental drug from Chinese drugmaker United Laboratories International. This newly acquired therapy is clearly a potential competitor to letaltortide, as it similarly uses a three-pronged approach to promote weight loss and regulate blood sugar levels.

The industry has made strides toward improving patient access to medicines, and management expects that to continue. Cash prices for Novo’s pills are already among the lowest seen on the market, starting at $149 for starting doses and up to $299 for higher doses.

GLP-1 injections cost about $1,000 per month before insurance, and there are no recent cash discounts.

Pfizer’s Bourla and Lilly’s Skovronsky said future Medicare coverage of obesity drugs should also change significantly.

“Once the government starts covering it in Medicare, it’s probably going to become more and more uncomfortable for employers not to cover it. That’s the social pressure,” Skovronski said.

He also pointed to a “consumer activation” in which patients are starting to call their employers and ask why their benefits don’t cover obesity drugs.

Skovronsky said drug companies, researchers and scientists are generating more data on the benefits of obesity drugs on health care spending, which could lead to expanded coverage for employers.

“So for employers, will absenteeism be reduced? Will productivity be increased? Will health care costs be lower?” he said. “Data is coming in, and more and more of it.”

Regarding the direct-to-consumer channel, Skovronski said this could become the “fastest growing segment” in the space, given the recent push by pharmaceutical companies to start selling cash.

Lilly was one of the first companies to launch a direct-to-consumer platform offering discounted obesity drug Zepbound in 2024, with Novo following more than a year later.

Bourla estimated that the direct-to-consumer channel already accounts for 30% of the U.S. obesity and diabetes drug market, adding that it could approach 90% or more of that market overseas.

Asked what the broader market will look like by 2030, Structure’s Stevens said he hopes access and affordability will no longer be an issue.

“It’s OK to have lower costs. For me, this was always about volume and really trying to address a huge unmet need around the world,” he said.