Weight-loss drugs will be sold as pills, with just as many side effects and cost issues
Novo Nordisk A/S and Eli Lilly & Co. are promoting pill versions of their blockbuster weight-loss medications, which could be available as early as next year. But if you’re hoping for something less expensive and with fewer side effects, think again.
Obesity pills in development have significant shortcomings in terms of ease of use and potential side effects that patients may not be aware of. And, if a Novo tablet already on the market is any indication, some will be as expensive as the injections that are already giving patients and insurers pause.
Shots like Lilly’s Zepbound and Novo’s Wegovy are more than just late-night talk show fodder: they’re a gold mine that has propelled the companies to dizzying valuations and enticed other drugmakers to enter the field. Pfizer Inc. and AstraZeneca Plc are looking into oral medicines to gain a foothold in a market that is expected to reach $100 billion in seven years.
“Orals will play a very significant role because not everyone likes injections,” Pfizer CEO Albert Bourla said at a September conference. Pascal Soriot, his Astra counterpart, envisions a pill that will “democratize” weight loss, making it more accessible to people in low-income countries.
Pills are generally easier for drug companies to manufacture, store, and transport than injections. So far, this has not resulted in a less expensive version of Novo’s Ozempic. Rybelsus, a pill version of the diabetes shot that is frequently used for weight loss, is already on the market for $936 for a one-month supply.
A high-dose Rybelsus version designed specifically for weight loss is being considered for European approval. Patients who took it once a day lost about 15% of their body weight in 16 months in a late-stage trial.
However, the pill has limitations: patients must take it on an empty stomach every day and then wait another half hour before eating. Nonetheless, more gastrointestinal side effects were reported in trials of the drug’s highest dose than in Wegovy injection studies.
The pill also requires far more active ingredient than shots, and that substance, semaglutide, is already scarce. Novo has postponed plans to file for US approval from this year to next, stating that the medication’s availability is dependent on manufacturing.
All of the new pills, like shots, mimic GLP-1, a hormone that makes people feel full. Lilly’s experimental pill, orforglipron, has “no restrictions in terms of food and water intake,” according to Lilly executive vice president Patrik Jonsson.
The once-daily pill produced nearly as much weight loss as the highest experimental dose of Rybelsus in roughly half the time, assisting patients with diabetes and obesity to lose nearly 15% of their body weight in just 36 weeks. Although nausea and vomiting were still common, experts said the results were unprecedented for a pill.
The Lilly pill “looks to be the best,” according to Truist Securities pharma analyst Joon Lee in an interview. While it is likely to be years before it is commercially available, it could give Lilly an advantage over Novo in a market that is still largely dominated by the Danish drugmaker.
Pfizer is looking to obesity drugs to help restore revenues after seeing pandemic sales dwindle. Pfizer is focusing on a pill that is now in a mid-stage study after discontinuing one experimental drug in June due to safety concerns. To compete with Lilly’s drug, Pfizer’s will need to show a weight-loss percentage in the mid-teens, according to Leerink Partners analysts.
According to Truist’s Lee, the risk of side effects may explain why Pfizer divided the drug into two daily doses in its trial.
According to an email from a Pfizer spokesperson, the company is still gathering and reviewing data about the pill and hasn’t seen any elevated liver enzymes that would indicate potential harm.
Obesity pills are also being tested by biotechs such as La Jolla, California-based Viking Therapeutics Inc. and Structure Therapeutics Inc. Structure’s, which is now in mid-stage human trials, has shown promising results that are “staunchly ahead” of Pfizer’s, according to BMO Capital Markets analyst Evan David Seigerman.
Even further out of the market is the pill that AstraZeneca licensed this month from China’s Eccogene in a $1.83 billion deal. In an interview this month, Astra’s Soriot stated that at least 75% of patients would prefer pills over shots. In addition, in contrast to the current crop of drugs, he anticipates a less expensive product.
“The cost of goods, we believe, is lower,” he said at Bloomberg’s headquarters in New York. “There are lots of people that can benefit at an acceptable price level.”
According to Louis Aronne, an obesity expert at Weill Cornell Medicine in New York who has advised major pharmaceutical companies on their efforts in the field, the current generation is only the beginning.
“There will be ten or more new drugs in the next five to ten years,” he said in an interview. “This is not the grand finale.
