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Drug companies are racing to be the first to market the next big innovation in the weight-loss industry. The pills could be effective, convenient, and affordable.
A pill that works for 40% of adults in the U.S. would be a huge opportunity.
It's still too early to declare a winner. This is especially true since several important data sets from pharmaceutical companies are due to be released later this year. There's also the important issue of pricing.
Even though the U.S. may not approve it first, an experimental oral drug developed by Eli Lilly has an advantage over Novo Nordisk's and Pfizer's pills.
The three manufacturers are all developing oral versions GLP-1s. This class of drugs mimics the hormone that is produced in the stomach to suppress an individual's appetite. Novo Nordisk’s Wegovy and Ozempic weight loss treatments are GLP-1 weekly injections, also known as semaglutide.
The injections are made in single-use pens. The oral drugs may help to alleviate the shortages of their injectable counterparts.
Pills tend to be cheaper than injections. However, it is not clear if this will apply with the new obesity pills.
Wegovy has a list price of over $1,300 for a monthly package. Ozempic is around $935. Novo Nordisk offers a low dose oral version of semaglutide for the same price as Ozempic per monthly package of 30 tablet. This pill, known as Rybelsus is only approved for Type 2 Diabetes.
The new weight loss pills are not yet priced by any of the three manufacturers.
Novo Nordisk holds a significant advantage. The Danish company, CNBC reports, has already published phase three clinical results for its high dose version of oral semaglutide that is intended for weight loss. It expects to apply for Food and Drug Administration (FDA) approval later this year.
Orforglipron is currently in phase three of Eli Lilly's clinical trials, which means it will likely be available later.
Analysts are still confident that orforglipron will remain competitive in the future, particularly after Eli Lilly released phase two results of its clinical trials last week, which highlighted the drug's high efficacy.
Eli Lilly phase two results show that overweight or obese patients taking 45 milligrams orforglipron daily lost up to 14.7% after 36 weeks. This compares to a weight reduction of 2.3% in people taking a placebo.
The results of Eli Lilly are consistent with those achieved by Novo Nordisk, but they were obtained over a shorter period.
According to results of a phase three clinical study released on Sunday, overweight or obese patients taking 50 milligrams once daily of Novo Nordisk’s drug saw an average loss of weight of 15.1%.
Geoff Meacham, a Bank of America research analyst, said in a research note published on Sunday that the orforglipron available from Eli Lilly "compares very favorably" with Novo Nordisk oral semaglutide. "Caveats about cross-trial comparisons aside," he added.
Louise Chen, Cantor-Fitzgerald analyst, told CNBC orforglipron may be able to achieve even greater weight loss if it is given a longer period of time.
Chen explained that the more you take these drugs, you will see more weight loss until it plateaus. Orforglipron will likely exceed semaglutide weight loss if it's close.
Chen stated that the hope was that orforglipron would lead to a weight reduction similar to Eli Lilly’s injection tirzepatide which led to a weight loss of 22% after 72-weeks.
Orforglipron's phase 3 clinical trials will be studied over a longer period of time.
Analysts say that, at least for the moment, Eli Lilly's pill could also be a better option than Pfizer's GLP-1 oral, danuglipron. This drug is still in its phase two clinical trial.
According to the results of a phase two clinical study, patients with Type 2 diabetes taking a 120 milligram version twice daily lost an average of 10 pounds after 16 weeks.
Due to the different patient populations and lack of long-term data, it's hard to compare danuglipron with other oral GLP-1s.
Pfizer's spokesperson told CNBC the company was still studying the drug and would "also look to have longer data in the future" beyond 16 weeks.
Wells Fargo's Mohit Bansal stated in a research report that Eli Lilly's orforglipron's data will make it difficult for Pfizer's oral GLP-1 to compete.
He said that doctors prefer to prescribe once-daily medications, such as orforglipron, over twice-daily ones like danuglipron.
Experts in the field of health seem to agree that a daily pill is a great way to increase patient compliance. "People often miss a few days a week if you have to take something two times a day," Dr. John Yoon said, an endocrinology prof at UC Davis Health.
Pfizer has developed a daily version of the drug danuglipron.
Bansal, the company's CEO, said that Pfizer would also stop developing lotiglipron. Bansal claimed it was "the more attractive GLP-1 in Pfizer’s portfolio" because it is only taken once daily. Pfizer's shares fell 5% Monday after this news.
Pfizer's and Eli Lilly's oral semaglutide has one major advantage over Novo Nordisk: there are no dietary restrictions.
According to the FDA label, patients should take Novo Nordisk’s oral semaglutide on an empty stomach in the morning with no more that four ounces plain water. The FDA label for the low-dose, approved version of the drug states that patients should wait 30 minutes after taking oral semaglutide before they eat, drink or take other oral medications.
According to Dr. Eduardo Grunvald of the Center for Advanced Weight Management at UC San Diego, this is because Novo Nordisk’s oral semaglutide contains peptides, which are more difficult for your gut to absorb.
CNBC reported that "if you take it along with food or drinks, it won't be absorbed as efficiently."
He said that Eli Lilly's and Pfizer's pills are non-peptide GLP-1s. These are more easily absorbed and do not require dietary restrictions.
Chen, from Cantor Fitzgerald, said that market research indicates that these restrictions are "a big negative" for patients. This makes the pills by Eli Lilly or Pfizer a convenient alternative.
Orforglipron, a weight loss pill from Eli Lilly, is the clear leader in this space. Its efficacy and ease of use as a daily pill without any dietary restrictions make it a top contender.
Chen said that the data that will be released later this year may change the situation: "Save some space for the new data that is coming."
Health experts like Grunvald are less concerned about naming the winner of the oral weight loss drugs space.
He said, "I believe these oral GLP-1s give us more options to choose from for people who may react differently to medicines." "That is the real future."