Eli Lilly diet pills may be better Pfizer, Novo Nordisk drugs

Drug manufacturers are scrambling to capitalize on the next major innovation coming to the weight loss industry: effective, convenient, and potentially affordable obesity pills.

About 40% of American adults are obese, making an effective pill a huge opportunity.

It’s too early to tell a winner, especially since important data from several pharmaceutical companies is expected to be released later this year. And for the major players, there is still the crucial issue of price reduction.

But for now, it is an experimental oral drug Eli Lilly seems to have an advantage over pills New Nordisk And Pfizer – although he can’t get US approval first.

All three manufacturers are making oral versions of GLP-1, a class of drugs that mimic the hormone produced in the gut to suppress appetite in humans. Novo Nordisk’s popular treatments Wegovy and Ozempic, which sparked a gold rush in the weight-loss industry last year, are weekly injections of GLP-1, also known as semaglutide.

Pills are easier to make than injections that come in disposable pens. This means that oral drugs may help reduce supply shortages associated with their injectable counterparts.

Pills are generally less expensive than injections, although it’s not clear if this is the case with obesity pills.

Wegovy’s list price is over $1,300 for a monthly plan, while Ozempic’s price is around $935. Novo Nordisk has a low-dose oral version of semaglutide that has the same list price as Ozempic of 30 monthly tablets. Marketed as Rybelsus, this pill is only approved for type 2 diabetes.

None of the three drugmakers have estimated the cost of the new obesity pills.

Novo Nordisk has one major advantage: The Danish company has released results from a phase three clinical trial for a high-dose version of oral semaglutide for weight management, and told CNBC it plans to file for Food and Drug Administration approval. Administration later this year.

Eli Lilly is still in the middle of phase three clinical trials for its oral drug, or forgliprone, which means it could come to market later.

Still, analysts are confident of orforglipron’s long-term competitive advantage, especially after Eli Lilly announced results from a phase II clinical trial last week that showed a strong efficacy profile. of drugs.

According to results from Eli Lilly’s second phase, overweight or obese patients who received 45 milligrams or forgliprone once daily lost 14.7 percent of their body weight after 36 weeks. This compares to a 2.3% weight loss for people taking a placebo.

Eli Lilly’s results are consistent with the weight reduction caused by the Novo Nordisk pill, but achieved in a shorter trial period.

Overweight or obese patients who took 50 milligrams of Novo Nordisk once a day saw an average weight loss of 15.1% after 68 weeks, according to the results of the third phase of the clinical trial published on Sunday.

Bank of America analyst Jeff Meacham said in a research note on Sunday that the available data on Eli Lilly or forgliprone “compare very well” with Novo Nordisk’s oral semaglutide “except for the cross-comparison guard.”

Louise Chen, an analyst at Cantor Fitzgerald, told CNBC that orforglipron could achieve even higher levels of weight loss in a longer trial period.

“The more you use these drugs, the more weight you lose, right?” Chen said. “So the idea is that if you come close to losing weight in half the time with semaglutide or forgliprone, you’re likely to exceed it.”

According to Chen, orforglipron is hoped to produce a reduction similar to Eli Lilly’s injectable tirzepatide, which results in about 22% weight loss after 72 weeks.

The company’s three phase three clinical trials of Orforglipron will study the drug over a long period of time.

So far, experts say Eli Lilly’s pill may outperform Pfizer’s oral GLP-1, dangliprone, which is still in phase II clinical trials.

Patients with type 2 diabetes who took a 120-milligram version of dangliprone twice daily lost an average of about 10 pounds after 16 weeks, according to the results of a phase II clinical trial.

Due to the different patient populations and the lack of long-term data on the drug, it is difficult to compare the efficacy of dangliprone with other oral GLP-1 agents.

A Pfizer spokeswoman told CNBC that the company is still studying the drug in a second phase II clinical trial and is “pursuing longer data” beyond the 16-week mark in the future. .

Wells Fargo analyst Mohit Bansal said in a research note that Pfizer’s danglipron is expected to compete in the oral GLP-1 space given Eli Lilly’s strong or forglipron data.

He says doctors usually prefer pills like dangliprone (or forgliprone) that are taken twice a day.

Health professionals seem to agree: “If it’s a once-a-day pill, patient compliance is greatly increased, so that’s a big plus. People disappear several times a week when they have to get something twice a day.” Dr. John Yoon, professor of endocrinology at UC Davis Health.

Pfizer is developing a once-daily version of dangliprone.

Also on Monday, the company said it would stop development of another experimental pill, lotigliprone, which Bansal said was “the most attractive GLP-1” in Pfizer’s portfolio because it was only taken once. per day. Pfizer shares fell 5% on Monday after the news.

But Pfizer and Eli Lilly share a key advantage of Novo Nordisk’s oral semaglutide: no dietary restrictions.

Patients should take Novo Nordisk semaglutide by mouth in the morning on an empty stomach with no more than four ounces of plain water, according to the FDA label for the approved low-dose version of the drug. They are advised to wait 30 minutes before eating, drinking or taking other oral medications.

That’s because Novo Nordisk’s oral semaglutide is a peptide drug that’s difficult to absorb in the gut, says Dr. Eduardo Grunwald, medical director of the Weight Management Center at UC San Diego.

“If you take it with food or drink, it’s not absorbed as efficiently,” Grunwald told CNBC.

He said the Eli Lilly and Pfizer tablets are non-peptide GLP-1s that are easily absorbed and do not require dietary restrictions.

Cantor Fitzgerald’s Chen said market research suggests such restrictions are “a huge inconvenience for patients,” making Eli Lilly and Pfizer pills a convenient alternative.

Overall, Eli Lilly’s or forgliprone appears to be a top contender in the diet pill space due to its efficacy data and convenience as a once-daily pill without dietary restrictions.

But Chen noted that data released later this year could change that: “Keep room for new data.”

For health professionals like Grunwald, naming a winner in the field of oral weight loss pills is a no-brainer.

“I think that oral GLP-1 means we have more tools in our toolbox, more options for different people who may react differently to different drugs,” he said. “It really is the future of everything.”