The weight problems medication that powered enormous investor features in 2023 are poised to encourage extra company dealmaking, scientific breakthroughs and higher affected person entry within the yr forward, analysts say.
Eli Lilly & Co.
LLY,
and Novo Nordisk
NVO,
the dueling pharmaceutical giants presently dominating the obesity-drug race, will doubtless rack up extra wins in 2024 as they search to remain forward of a rising pack of contenders. But there’s nonetheless loads of room for extra gamers on this area of interest, analysts say, as firms develop tablet variations of the favored GLP-1 medication in addition to new drug candidates that promote weight reduction whereas preserving lean muscle.
Key clinical-trial knowledge rising over the subsequent yr “will really start to dictate who will be the competitors against Lilly and Novo,” mentioned Damien Conover, director of healthcare analysis at Morningstar.
While new, next-generation weight problems medication aren’t more likely to hit the market in 2024, fascination with these drugs isn’t about to fizzle out, with some analysts projecting the market may develop to $100 billion over the subsequent 5 to seven years. But with Novo and Lilly shares up greater than 50% this yr, buyers are searching for the up-and-comers within the fast-growing market.
The highlight on the highly effective new medication and their broader well being advantages, in the meantime, ought to assist spur expanded insurance coverage protection of the medicines and higher public understanding of weight problems within the yr forward, consultants say.
“We’re making leaps forward in the public understanding of this condition, but there’s still plenty of misunderstanding,” together with the notion that sufferers can get a fast weight-loss repair with these drugs after which transfer on, mentioned Ted Kyle, founding father of the weight problems and health-advocacy group ConscienHealth. “Weight loss is just a tiny part of taking care of obesity,” Kyle mentioned. “The big part is managing health over the long term.”
Here are 5 tendencies to observe within the obesity-drug world in 2024.
1. More wins for Lilly and Novo
With Zepbound, probably the most potent weight problems drug in the marketplace, hitting U.S. pharmacy cabinets in latest weeks, “Lilly is off to the races,” mentioned Evan David Seigerman, managing director of biopharma fairness analysis at BMO Capital Markets. While it’s nonetheless early, Zepbound seems to be having “a very robust launch,” Seigerman mentioned.
Zepbound “is the drug to beat right now,” Conover mentioned, and in 2024, “the biggest competitor for Lilly is Lilly.” The firm is growing the much more highly effective next-generation drug retatrutide, which in a Phase 2 examine helped sufferers lose a median 58 kilos after 48 weeks. Lilly can be engaged on orforglipron, a tablet model of the GLP-1 medication.
Analysts additionally see a number of doubtlessly optimistic developments in 2024 for Novo Nordisk. A Wegovy label growth subsequent yr may replicate the cardiovascular advantages demonstrated within the trial outcomes launched by the corporate this yr.
Novo can be anticipated to launch some late-stage trial knowledge in 2024 for CagriSema, which mixes Wegovy with the investigational drug cagrilintide and thus far seems to advertise extra weight reduction than Wegovy alone, with restricted unwanted effects. The firm lately launched a medical trial testing CagriSema towards Lilly’s Zepbound. CagriSema “could create a longer trajectory for Novo” within the obesity-drug market, Conover mentioned.
“This party is just getting started,” Cantor Fitzgerald analysts wrote in a latest report initiating protection of Novo Nordisk’s inventory with an chubby ranking and a $120 worth goal.
2. More dealmaking
Obesity medication have been on the middle of a number of main offers this yr — a development that’s more likely to speed up in 2024, analysts say.
Roche Holding AG
RHHBY,
earlier this month struck a deal to purchase obesity-drug developer Carmot Therapeutics for as much as $3.1 billion, whereas AstraZeneca PLC
AZN,
mentioned in November that it will license an experimental weight problems and diabetes therapy from Shanghai firm Eccogene.
There are nonetheless loads of offers to be made within the obesity-drug world in 2024, analysts say. In years previous, many massive pharmaceutical firms “left cardiometabolic drugs because the innovation wasn’t there, the pricing power wasn’t there. They don’t have them in their pipeline,” Conover mentioned. Now, the chance is just too massive to disregard, so “they’ll go into their deep pockets of cash and go after smaller firms that have stayed in the space.”
Potential targets for such offers, analysts say, embody firms like Viking Therapeutics Inc.
VKTX,
which is engaged on a drug that mimics the actions of the intestine hormones GLP-1 and GIP, just like Lilly’s Zepbound. Other smaller gamers like Zealand Pharma
ZLDPF,
may additionally look attention-grabbing to the massive firms, analysts say.
In addition to acquisitions, “there will be a whole host of partnerships,” Conover mentioned. Altimmune Inc.
ALT,
whose investigational weight problems drug pemvidutide has optimistic Phase 2 trial knowledge, for instance, is searching for a associate because it advances to late-stage trials.
3. No magic capsules
Pill variations of the favored GLP-1 medication may doubtlessly be cheaper and extra accessible for sufferers — and play an vital function as upkeep drugs as soon as individuals obtain their goal weight reduction on injectables, analysts say.
But there have been some high-profile setbacks on this area of interest in latest weeks. Pfizer Inc.
PFE,
mentioned earlier this month that it’ll halt improvement of the twice-daily formulation of its investigational tablet, danuglipron, after sufferers taking the drug in a medical trial reported excessive charges of nausea and different unwanted effects. The firm is continuous work on a once-daily type of danuglipron, and extra knowledge on that model, anticipated subsequent yr, may “reshape the competitive landscape,” Conover mentioned.
“Pfizer’s example shows it’s not easy” to supply an oral GLP-1 drug, and the corporate’s latest disappointment with danuglipron most likely units Pfizer again a yr in its timeline to enter the obesity-drug market, Conover mentioned.
Structure Therapeutics Inc.
GPCR,
additionally launched new knowledge on its diabetes and weight problems tablet this week that dissatisfied buyers and pummeled the inventory. The knowledge instructed that the tablet is much less efficient than Lilly’s orforglipron — however with longer period and better dosing, Structure’s candidate nonetheless has potential and extra knowledge is anticipated in 2024, Leerink Partners analysts mentioned in a analysis word Monday.
While there’s a well-liked notion that sufferers would possibly favor capsules to injections, some docs are skeptical of the capsules’ potential. “I think an injectable is the way to go,” mentioned Dr. Caroline Apovian, co-director of the Center for Weight Management and Wellness at Brigham and Women’s Hospital and a professor of medication at Harvard Medical School. Patients on injectables, Apovian mentioned, “seem to have much less nausea and vomiting than when you try to make it an oral agent.”
4. Drugs in improvement will purpose to protect muscle, rein in unwanted effects
Drugs within the pipeline — together with Lilly’s retatrutide; Novo’s CagriSema, a once-monthly injection in improvement at Amgen Inc.
AMGN,
; and Altimmune’s pemvidutide — are “really, really exciting,” Apovian mentioned, as a result of they’re demonstrating nice weight-loss advantages utilizing some completely different mechanisms than medication presently in the marketplace.
A giant remaining problem for drugmakers, Apovian mentioned, is to ship greater ranges of weight reduction with out the nausea, vomiting and different unwanted effects generally seen with these medication. “We’re not there yet,” she mentioned, noting that the unwanted effects could stay a longer-term problem, managed by means of methods equivalent to steadily rising dosage.
Another unmet want, analysts say, is for medication that may protect muscle whereas selling weight reduction. Significant weight reduction typically reduces lean muscle in addition to fats. That is usually a specific difficulty for older adults, who’re additionally weak to sarcopenia, the age-related lack of muscle mass and power.
Some main gamers out there, together with Eli Lilly, are already on the case. Lilly this summer time reached a deal to amass Versanis Bio, whose lead asset bimagrumab is a monoclonal antibody designed to deal with muscle loss. Roche additionally has muscle-preserving drug candidates, strengthening its place because it steps into the weight problems market with Carmot, analysts say.
“That would be absolutely huge if you can not only provide weight loss, but the right part of the weight loss” by burning off fats however not muscle, Conover mentioned. “Right now it’s a blunt focus.”
5. More insurance coverage protection, higher affected person entry to medication
“These drugs are no good if people can’t get them” due to lack of insurance coverage protection, provide points or different obstacles, Kyle mentioned.
The provide points which have plagued among the medication presently in the marketplace ought to dissipate by the top of subsequent yr, Conover mentioned, as each Lilly and Novo are spending closely to construct extra manufacturing capability.
Although insurance coverage protection of the medication stays spotty, a possible turning level got here this yr with the foremost Novo Nordisk examine demonstrating Wegovy’s cardiovascular advantages. “With that data in hand, it’s no longer possible for people to say it’s a cosmetic, behavioral issue,” Kyle mentioned. “It’s a physiologic, life-sustaining treatment.”
The mounting proof of the medication’ broader well being advantages is already rising scrutiny of Medicare’s decades-old exclusion of weight-loss medication from its protection. Eventually, Medicare will cowl the medication, Conover predicts, though it’s going to doubtless require legislative motion.
Medicare protection is also important for individuals in industrial well being plans, Seigerman mentioned, as a result of “commercial typically mirrors Medicare.”
Roughly 50 million individuals within the U.S. have already got protection for weight problems drugs, Seigerman mentioned, and the development towards broader protection ought to proceed as drugmakers work with insurers on easy methods to get entry with “guardrails” equivalent to prior-authorization necessities. “The employers and payers want to prevent willy-nilly prescribing of a GLP-1 that’s going to break the healthcare system,” Seigerman mentioned. “Using it to treat patients who are actually obese, who have a medical condition, isn’t going to break the healthcare system.”
Ultimately, nevertheless, “it would help if insurance companies would cover these agents without prior authorization,” Apovian mentioned, as a result of all of the paperwork necessities can discourage busy primary-care docs from prescribing the medication. Currently, she mentioned, primary-care docs typically see sufferers with weight problems and deal with their blood sugar, blood strain, ldl cholesterol and different points with out ever discussing their weight. “That’s what has to change,” she mentioned. “Primary care must be empowered or incentivized to treat the obesity first.”
Source web site: www.marketwatch.com
