减肥药竞赛进入新阶段：口服药与更强效药物涌现

It's been five years since the FDA approved Novo Nordisk GLP one shot with Govee for weight loss, and that shot in a similar one from Eli Lilly called Zepbound, have transformed the treatment of obesity, helping people lose a significant amount of weight. The drugs are also used now to treat other conditions like sleep apnea and heart problems. Behind these shots, Lilly and Novo have just started rolling out pills, and there are dozens more drugs behind them, including the most powerful drug we've seen yet, Lilly's Retatrutide.

I went to the premier obesity meeting the American Diabetes Association's to get a look at what else is inside the pipeline. Novo and Lilly introduced GLP one pills earlier this year, and signs of the competition between those two heavyweights were all over the conference. Novo had cars decked out with Wegovy pill ads driving outside the convention center while Lilly's phone ads were plastered on the floor and more pills could be coming.

I caught up with Ray Stevens, the CEO of Structure Therapeutics, which shared phase two data showing that its pill could help people lose about 16% of their body weight. That's similar to the pill. Those structures pill is closer to Lilly's pill form and that it's a small molecule, not a peptide. So those are easier to make and they can be taken like most other pills that people are familiar with. I asked Stevens if there's really going to be room for new pills by the time structure reaches the market in a few years, assuming that drug succeeds in the phase three trial, that will start later this year.

Who wins at the end of the day with competition patients. And that's really what this is all about. We're pushing really hard to get into that second position behind Orforglipron. What I'm also excited about is besides the GLP one space, we're continuing to see innovation. We think that oral small molecules are really the solution. The data that stole the show, Lilly's Retatrutide, that experimental drug is a triple agonist, so it turns on three hormone receptors GLP-1, GIP, and glucagon.

Lilly's current shot, Zepbound, is a dual agonist that activates the GLP one and GIP receptors, and the thinking was that adding glucagon would result in even more weight loss, and retatrutide delivered. People lost an average of 28% of their body weight at the highest dose when they stayed on the treatment, and nearly half of people lost more than 30% of their body weight. And that's the level that's associated with bariatric surgery.

That's the most weight loss that we've ever seen a drug produced to date. And I could hear someone behind me audibly reacting to the results. But the drug is so powerful it probably won't be used as broadly as Zepbound and Wegovy. People with higher body mass index, higher body weight, where a product like Zepbound is incredibly effective. But 8% of our country is BMI over 40. And even if you're at that level and you have an average response to Zepbound, you're not going to be healthy.

Body weight with Register, we showed what's possible, which is a meaningful. Almost half the people lose more than 30% of their body weight. So if you do start at a higher level, you can really get to a more healthy state, which is everyone's goal, I think. Now, the question facing all the other companies developing obesity drugs is how much room there really is for more medicines. In the presentation for Pfizer's experimental monthly GLP one shot, a doctor showed a slide of dozens of drugs in the pipeline that could be available in 2029, around the time when Pfizer's drug might launch.

Novo CEO Mike Doustdar shared some of his thoughts on how the treatment of obesity might change in the coming years, and what that means for Novo. Most people consider obesity as synonymous with weight loss. I think that that is too narrow and too simplistic. If I think about 20, 30, 40 years ago, if you would have said mental health, people would have probably labeled that as one thing. Um, today that's depression to bipolar, to schizophrenia to many, many different issues with very distinct different medications and, and support for, for the patients.

We review obesity that way. I think we're going to be very diversified, but all of it within the area of cardiometabolic, um, per se diabetes, obesity, cardiometabolic and some of the adjacencies. One angle that some companies are pursuing is drugs with fewer side effects. And that's the premise of a drug from Zealand Pharma and its partner Roche called Petrelintide. That experimental drug is an amylin analog, meaning that it mimics amylin, which is another hormone that's produced in the pancreas and it makes you feel full.

In a phase two study, the weekly shot helped people lose about 11% of their body weight. That's lower than Wegovy and zepbound, but Zealand thinks that it has the edge on side effects, particularly vomiting. And he thinks that that tolerability will be crucial in the next decade. When these amylin launches. We can have that what I've described as an iPhone moment, because patients are so aware of the experience they have on a GLP one.

And once you you launch a new modality that gives you a better experience. We think people will queue up to get access to that new weight loss medication, rather than staying on the more cumbersome medicines. Then you have companies like Pfizer and Amgen pursuing shots that don't need to be taken as frequently. Amgen's testing monthly and quarterly dosing of its experimental drug called maritime. There's many different reasons why patients come off therapy and injection, of course, once a week or even like I know there's benefits out of orals, but again, that's a daily burden of remembering your disease.

And so we think being able to dose less frequently may give an advantage there. There's so much happening in the weight loss space. And we'll be tracking updates on all of these developments in the years to come.