These Are Ozempic And Wegovy's Weight Loss Drug Competitors

The stellar success of blockbuster drugs like Ozempic, Wegovy, Mounjaro and Zepbound has companies eager to break into the lucrative weight loss drug market — here are the hopeful rivals preparing to challenge Eli Lilly and Novo Nordisk for dominance in the obesity drug gold rush.

Key facts

• Danish biotech Zealand Pharma and German drug company Boehringer Ingelheim are jointly developing survodutide—an injectable drug that mimics the same GLP-1 gut hormone as Wegovy and Zepbound and another hormone called glucagon—which has produced strong results in mid-stage clinical trials as both an anti-obesity drug and a treatment for fatty liver disease and has moved forward to late-stage testing.
• San Diego-based Viking Therapeutics marked itself as a serious competitor in the weight loss drug market last month after revealing promising data from a mid-stage trial of experimental drug VK2735, which suggested it rivaled—and outperformed—Novo and Lilly drugs when given as a weekly injection and the company said it expects to release early data on an oral version by the end of March.
• Terns Pharmaceuticals is developing an oral weight loss drug targeting the GLP-1 hormone and expects to release 28-day data on weight loss from an early-stage trial in the second half of 2024.
• San Francisco startup Structure Therapeutics is also working on an oral GLP-1 drug—a larger mid-stage trial is slated to launch this year, and a late-stage trial is planned for 2026—which showed promise in a mid-stage trial, though the data underwhelmed investors.
• Maryland-based Altimmune released promising mid-stage trial results for injectable drug pemvidutide—which is in the same class as Wegovy, Ozempic, Zepbound and Mounjaro—and CEO Vipin Garg told Reuters the firm is actively looking for a global partner to help with late state trials and to help launch the drug.
• U.S. pharma giant Pfizer scrapped two experimental weight loss pills last year—a once-daily pill, lotiglipron, in July due to elevated liver enzymes and a twice-daily pill, danuglipron, in December due to strong side effects in a mid-stage trial—but CEO Albert Bourla has said the company is determined to “play and win” in the obesity space, with plans to develop danuglipron as a once-daily formulation to ease side effects.
• California biotech behemoth Amgen is hoping for a slice of the market with MariTide, a monthly injection that is taken less frequently than popular weekly treatments from Lilly and Novo and also appears to help some patients maintain weight loss after they stop taking it, a key issue emerging for patients on current treatments.

What are Lilly and Novo doing to stay ahead?

While semaglutide and tirzepatide—respectively the generic names for the active drug in Wegovy, Ozempic, Mounjaro, and Zepbound—dominate the weight loss drug market (Mounjaro and Ozempic are only licensed for diabetes), neither Novo Nordisk nor Eli Lilly are resting on their laurels. Both are refining existing medications and developing next generation drugs to shore up their position in the future. Novo, for example, is developing an oral version of semaglutide intended for once-daily treatment as well as new drugs like the injectable CagriSema, a combination drug that targets GLP-1 and another hormone, amylin, which regulates hunger. It is also developing amycretin in pill and injectable format, which is a single molecule targeting GLP-1 and amylin. Early data on the pill suggests amycretin could outperform Wegovy. Lilly, which secured approval for Zepbound in November, is working on a suite of new drugs including orforglipron and retatrutide, which hope to build on the weight loss in Zepbound and are both in late-stage trials.

Key background

It is still going to be years before Novo Nordisk and Eli Lilly have serious competition for their popular weight loss treatment on pharmacy shelves. While the process varies, it can take between 10 and 20 years to usher a new drug through all three phases of clinical trials and most drugs ultimately fail during clinical testing. There is no guarantee promising results on efficacy, safety and tolerability from earlier trials will be replicated in larger late-stage trials. Even companies with candidates already in the later stages of testing are still going to require several years to gather and process the data and, should things pan out, time to work with regulators to secure approval. Launching the drug is another matter entirely and shoring up enough supplies has proven difficult even for companies the size of Lilly and Novo, who have continually failed to meet demand. Despite investing billions to ramp up production, both drugs are in short supply and both companies readily admit they are unlikely to meet demand in the near future.

Tangent

Bringing a drug to market is also a costly and logistically complex process, especially during the later stages of development and it is not uncommon for promising candidates, or even entire companies, to change hands. Pharma giants, who are increasingly replacing innovation with mergers and acquisitions, are known to scoop up promising drugs, portfolios or companies. Several have already happened in the weight loss space: Swiss heavyweight Roche inked a $2.7 billion deal for weight loss drug developer Carmot Therapeutics, whose once-weekly injection, CT-388, is in the same class as Lilly’s Mounjaro and Zepbound and British giant AstraZeneca paid up to $2 billion for an experimental pill from Chinese firm Eccogene. Often, smaller companies will also seek partnerships or acquisition deals with larger pharma firms to help with the later stages of development for promising candidates. Altimmune’s Garg said the company is looking for partners for the later stages of development but would be open to considering deals with big pharma firms if they benefited shareholders.

Big number

$100 billion. That’s how much the weight loss drug market will be worth by 2030, according to some analysts. Some think the market is potentially worth much more and both Novo and Lilly raked in billions from their GLP-1 drugs last year (which are also used to treat diabetes). There are now more than 50 weight loss drugs in various stages of clinical development from about 40 companies, according to Bloomberg Intelligence.

What to watch for

Analysts told Forbes Lilly and Novo are likely to continue to dominate the market for the foreseeable future. Being first to market has given them a sizable first mover advantage and their sheer size will help consolidate their positions through the deals they make with pharmacies, healthcare providers and insurers. Both are also gathering data on how their anti-obesity drugs affect issues like cardiovascular disease and kidney disease, which could be used to help market the drug and secure further buy-in from governments and insurers who may have been unwilling to fund medication for what many still view as a lifestyle problem. Analysts told Forbes such data could be pivotal in securing the two companies’ position in the market and give them a powerful advantage over competitors entering with indications for weight loss alone. Novo secured such an advantage last week when the Food and Drug Administration authorized a label expansion for Wegovy to include cardiovascular benefits.