Stakes are High: Race for the Obesity Market

Obesity is a rapidly growing global health issue. According to the World Obesity Federation, approximately one billion people worldwide will be affected by obesity by 2030. Obesity has become big pharma's latest obsession, with significant interest and investment in this space. Both big pharma and small startups are jumping into the race, investing billions in combating obesity. Let's delve deeper into what's driving the appetite for obesity drugs.

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Current Industry Landscape

In 2021, Novo Nordisk gained approval for semaglutide, branded as Wegovy, for chronic weight management. Eli Lilly followed in 2024 with tripeptide, marketed as Zepbound. These drugs were instant hits, and the companies struggled to meet the demand.

The blazing success of weight loss drugs like Wegovy and Zepbound has fueled intense interest in new obesity treatments. According to IQVIA, 123 drugs are in development for obesity: 

• 36 in Phase 1,

• 35 in Phase 2, 

• 13 in Phase 3, and 

• 8 already on the market.

  
  

While Eli Lilly and Novo Nordisk lead the market, other major players such as Amgen, Roche, AstraZeneca, and Boehringer Ingelheim have joined the fray. Additionally, Zealand Pharma and Boehringer Ingelheim have collaborated on survodutide, a drug targeting GLP-1 and glucagon, which has shown promising early results and is currently undergoing phase 3 studies. Amgen's leading obesity candidate, AMG 133, has demonstrated promising results in early trials and is planning phase 3 trials.

Swiss pharmaceutical giant Roche made its foray into the weight loss sector by acquiring the American biotech Carmot for $2.7 billion. This acquisition added three clinical-stage obesity programs to Roche's portfolio, including CT-388, an injectable GLP-1, and CT-996, an oral GLP-1. Despite shelving its late-stage candidate due to significant side effects, Pfizer remains optimistic about advancing next-generation obesity drugs.

The Growing Market and Need for Innovation

Obesity is described as a trillion-dollar healthcare issue and a 100 billion-dollar market opportunity for pharma companies, making it a lucrative revenue stream for big pharma, which is forever in search of blockbuster drugs. Studies suggest that by 2035, half of the world's population will be overweight or obese, with 70 percent of U.S. adults falling into this category. Obesity-related health issues such as sleep apnea, fatty liver disease, diabetes, cardiovascular disease, and musculoskeletal disorders are a significant financial burden on healthcare systems. All of this, combined with the following: "The drugs are also turning out to be used long-term, so they are not curative but require ongoing therapy, which is recurring revenue for pharmaceutical companies," said Patrick Smith, President of Certara Drug Development Solutions at Certara, shows that there is a need for more innovation.

It is worth noting that most current treatments for obesity, such as GLP-1 receptor agonists like liraglutide and semaglutide, were initially designed for type 2 diabetes. GLP-1 agonists, including dual and triple agonists, are anticipated to remain the predominant mechanisms of action in obesity treatment. Nevertheless, researchers are also exploring alternative approaches to combating obesity.

There is a wealth of obesity treatments currently in clinical trials, which indicate potential directions that pharmaceutical intervention may take in the future. Several new GLP-1 receptor agonists are under investigation, individually and in combination with other mechanisms, such as GIP and glucagon agonists. Developing small molecule, orally effective agents in the GLP-1 receptor agonist class is a particularly compelling avenue, as these may alleviate the need for injection. Amylin, which signals satiety and slows gastric emptying, is another hormone of interest for researchers exploring the potential of analogs and receptor agonists. There is also interest in using tocotrienols to increase adiponectin expression and, as a result, aid in addressing insulin resistance. 

Historical Context, Trends, and Future Directions

"While these are only a sample of anti-obesity medications in development, the overall trend is promoting appetite reduction and satiety,” said Simon Bruce, Vice President of Internal Medicine and Drug Development Solutions at ICON, a leading CRO.

The trend is gaining momentum, mainly since previous weight loss drugs had limited success.

Historically, methods of treating obesity have been limited. Lifestyle modification—such as diet, exercise, and behavioral therapy—rarely considers significant risk factors, including genetics, environment, and other elements outside a patient’s control. Lifestyle modification alone is insufficient in achieving lasting weight loss. Case in point: Patients who lose weight through lifestyle changes typically regain 80 percent of the weight lost within five years. Hence, pharmacological intervention is an essential option for obesity treatment.

Before the early 2010s, physicians had limited options for prescribing obesity treatments, with phentermine being one of the oldest approved in 1959. Research in the early 2000s led to the approval of three more treatments, Qsymia, Belviq, and Contrave, in 2012 and 2014. While these drugs showed more significant weight loss compared to placebos in trials, their effects were considered modest, leading to limited adoption. Qsymia faced safety concerns such as fetal toxicity and heart issues, while Belviq was withdrawn in 2020 due to potential cancer risks. Also, earlier approved drugs resulted in 2-10 percent weight loss, and newer drugs like Wegovy and Zepbound have demonstrated substantial results, achieving up to 20 percent weight loss.

These drugs are crucial in addressing the escalating obesity crisis, with current statistics showing that 1 in 7 adults worldwide live with obesity. This number continues to rise among children and young people. Obesity is associated with heightened risks of diseases like type 2 diabetes, heart disease, and certain cancers. Without effective intervention, the economic costs of overweight and obesity are projected to surpass $4 trillion globally by 2035, according to The World Obesity Atlas 2023.

Below are more statistics regarding obesity.

Conclusion

"Obesity is a ‘gateway’ disease that is linked to many complications and disorders – some of which may impact life expectancy and health-related quality of life. Weight loss is associated with notable health benefits and improvement in various obesity-related complications. However, current pharmacotherapy treatment options for weight management are limited, and we believe there is a need for additional effective treatment options that can help people living with obesity and obesity-related complications,” said a spokesperson from Novo Nordisk.

As research and development of these drugs mature, they will reshape not only the treatment of obesity but also our understanding of the disease. Due to the complexity of obesity as a disease and the difficulties inherent in maintaining weight loss, in many cases, one single solution is not enough. Instead, a blend of different approaches or medications may be required to affect the desired outcomes for a patient. 

References

1. Novo Nordisk Capital Markets Day, obesity care presentation, 7 March 2024: https://www.novonordisk.com/content/dam/nncorp/global/en/investors/irmaterial/cmd/2024/P5-Obesity-Care.pdf

2. IQVIA Institute report, 2024: The Global Use of Medicines 2024

3. Reuters, 28 April 2023: Denmark's largest health insurer drops weight-loss drug coverage as demand soars

4. https://www.iqvia.com/blogs/2024/05/when-the-dust-settles

5. FDA orange book - https://www.fda.gov/drugs/drug-approvals-and-databases/approved-drug-products-therapeutic-equivalence-evaluations-orange-book