Weight loss is the future golden goose of the drug market

Reminder: It is strongly recommended that you read my other highly relevant post after reading this article “Novo Nordisk’s new diabetes drug Semaglutide,Ozempic,Wegovy and Mounjaro found to have surprising weight-loss effects“

Table of Contents

The potential weight loss opportunities

How many people need to lose weight?

Worldwide

According to statistics from the 2018 European Obesity Conference: In 2017, the global obese population rate was 14%, and 9% had type 2 diabetes. By 2045, the two data will become 22% and 12%; 39% in 2045 to 55%.

U.S.

According to a 2023 study in the Journal of the American Medical Association, between 2009 and 2020, the prevalence of diabetes in American adults rose from 3% to 4%, and the obesity rate rose from 32.7% to 40.9%. Healthcare spending reached $173 billion.

According to the National Institutes of Health, more than two-fifths of American adults are obese, and about one in 10 is severely obese.

China

The National Health and Medical Commission of China pointed out in 2021 that the overweight rate of Chinese adult residents exceeds 50%, and 16.4% of them are obese.

Europe

In the WHO European Region, overweight and obesity affect nearly 60% of adults and almost one third of children (29% of boys and 27% of girls).

Taiwan

According to statistics from the National Health Service of the Ministry of Health and Welfare, the prevalence rate of overweight and obesity among adults in Taiwan is 43%, with 48.9% of males and 38.3% of females.

How big is the weight loss market

Baron’s Weekly reported that incretin has unprecedented weight loss effects. Even safely lose a fifth of your body weight, and it is expected to become the world’s best-selling drug. It is estimated that the annual sales of incretin will exceed US$50 billion from 2030, and the market will be divided between Novo Nordisk and Eli Lilly.

The current market size for weight loss is US$1 billion, and it can easily exceed US$10 billion in the next few years. Including Eli Lilly (ticker: LLY), Novo Nordisk (ticker: NVO), Amgen (ticker: AMGN), Pfizer (ticker: PFE), Regeneron (ticker: REGN ), Merck (ticker: MRK), Roche (ticker: RHHBY), GSK (ticker: GSK), Rhythm Pharmaceuticals (ticker: RYTM ) and other global pharmaceutical giants have joined the battlefield, and have or are developing related products, aiming at this blue ocean market that is expected to reach an annual revenue of US$50 billion within ten years.

Goldman Sachs predicts that the weight-loss drug market is expected to reach US$100 billion. By 2030, the global anti-obesity drug market may grow to approximately US$100 billion (annual sales at the beginning of 2023 are approximately US$6 billion). This projection is based on approximately 15 million U.S. adults receiving weight loss medications for chronic weight loss management in 2030, and approximately 105 million U.S. adults being obese or overweight. Analysts exclude people with diabetes from obesity forecasts.

When do you need to lose weight?

According to the regulations of the US FDA, the above weight-loss drugs can only be used if the following conditions are met:

BMI greater than 30
BMI greater than or equal to 27 and related diseases

Weight-loss drugs approved

FDA

Six diet pills have been approved by the U.S. Food and Drug Administration (FDA) for long-term use:

Brand name	Generic name	Pharmaceutical company	Available year	Weight loss in 1 year	Mechanism
Xenical	Orlistat	Roche, GSK	2007	11.0%	脂肪分解酵素抑制劑
Qsymia	Phentermine-Topiramate	Vivus	2012	9.3%	加強去甲腎上腺素和多巴胺的神經傳遞來產生抑制食慾
Contrave	Bupropion-Naltrexone	Nalpropion	2014	5.2%	選擇性去甲腎上腺素和多巴胺再攝取抑製劑
Saxenda	Liraglutide	Novo Nordisk	2014	5.6%	GLP-1受體上的腸泌素藥物
Imcivree	Setmelanotide	Rhythm Pharmaceuticals	2020	10.0%	MC4R激動劑
Wegovy	Semaglutide	Novo Nordisk	2021	15.0%	GLP-1受體激動劑

Table 1: Six Weight Loss Drugs Approved by the FDA

Taiwan Ministry of Health and Welfare

At present, there are only two legal weight-loss drugs approved in Taiwan:

Xenical
Belviq

How many well-known weight-loss drugs containing enterocrin are there?

Saxenda

The main ingredient in Novo Nordisk’s Saxenda weight loss daily injection pen is Liraglutide, which is improved from Victoza, a prescription drug that was originally prescribed for patients with type 2 diabetes. For weight loss indications in adults, it is an incretin drug that acts on the GLP-1 receptor. Novo Nordisk’s 1-year clinical results indicated that about 60% of the subjects lost less than 5% of their body weight, and 34% of them lost more than 10%.

Trulicity

Eli Lilly’s Trulicity is a once-a-week pen injection that contains dulaglutide, a GLP-1 receptor enhancer, and belongs to the enterocrin type of blood sugar control drug.

Efinopegdutide

Merck’s (tickere: MRK) drug Efinopegdutide, which reduces fatty liver, has shown a better effect than the FDA-approved drug semaglutide in the second phase of clinical trials, and can reduce fatty liver by about 70%. Body weight is reduced by about 8%.

Semaglutide

Simple bio

Semaglutide was developed by Novo Nordisk in 2012. It is a GLP-1 receptor agonist. The trade names on the market are Ozempic, Wegovy and Rybelsus. The difference among these three is the difference in dosage.

Three FDA-approved semaglutide drugs

At present, Novo Nordisk has three semaglutide drugs approved by the FDA, and the brand names are Ozempic, Wegovy and Rybelsus (oral dosage). Among the three drugs, only Wegovy (2.4mg, once a week) has been approved by the FDA for weight loss indications for chronic chronic weight management.

Ozempic

In December 2017, Ozempic was approved by the FDA for the treatment of type 2 diabetes. It can stimulate the body’s insulin production. It is administered once a week, reduce appetite and help people lose weight significantly. After 56 weeks of testing, patients who received low-dose semaglutide lost an average of 4.3 kg in weight, and those who received high-dose semaglutide lost 6.1 kg.

Wegovy

Novo Nordisk will be approved by the FDA in 2022 and marketed under the brand name Wegovy. It is an injectable weight loss drug that specializes in weight loss. According to the Novo Nordisk study, Wegovy participants lost an average of 15% of their body weight, about 34 pounds, and the weight loss remained stable after 14 months.

On August 8, 2023, Novo Nordisk announced that Wegovy has been found to have a potential role in reducing the risk of serious cardiovascular diseases. The latest clinical results allow Novo Nordisk to apply for a new indication for Wegovy, which will increase the usage rate of Wegovy by about a quarter and bring more revenue to the company. On that day, all weight-loss-related stocks in the U.S. stock market rose by at least ten percent, and the stock price of Novo Nordisk, which is listed in the U.S., soared by more than 16%.

Danuglipron

Pfizer expects to finalize Danuglipron’s phase III clinical trial plan by the end of 2023. Danuglipron and Novo Nordisk’s blockbuster weight-loss injections Ozempic and Wegovy are drugs for the glucagon-like peptide-1 (GLP-1) hormone. Pfizer Chief Executive Albert Bourla said the weight-loss drug could eventually generate $10 billion in annual revenue for the company.

Monzaro is the superstar of the future

The future Eli Lilly bets

Eli Lilly’s incretin drug is called tirzepatide and is marketed as Mounjaro. Approved by the FDA in 2022 for the treatment of type 2 diabetes in adults, it is a dual incretin (GLP-1 and GIP) agonist, the first new type of diabetes drug in ten years, administered once a week by subcutaneous injection , will become a heavyweight competitor of Novo Nordisk.

Benefited from August 8, 2023, Novo Nordisk announced that the company’s weight-loss drug Wegovy has potential new indications in the field of reducing the risk of serious cardiovascular diseases, and also has GLP-1 receptor agonist drugs Eli Lilly shares also rose sharply. In addition, on the same day, the company announced the results of the second quarter financial report, the most important of which was driven by the weight-loss drug Monzaro. The new product contributed US$1 billion in revenue in the second quarter, and the closing stock price soared more than 100 million dollars in one day. 14%, the market value surpassed Johnson & Johnson to become the most valuable listed pharmaceutical company in the world again.

Amazing weight loss

Although tirzepatide is not yet approved for weight loss, the new drug has catapulted Lilly into one of Wall Street’s favorites. Lilly announced on April 28, 2022 that subjects could lose an average of 15% of their body weight if they took a low dose; if they took a high dose, they could lose an average of 22.5% of their body weight. The results could speed up the drug’s FDA approval.

According to the latest interim clinical trial results released on 6/26/2023, the second phase of the trial followed 338 obese or overweight adults. The subjects took Eli Lilly’s experimental drug tirzepatide weekly to help patients lose weight for nearly a year. They lost up to 24% of their body weight, the highest rate of weight loss ever seen in the field of obesity treatment. Even after only taking it for 24 weeks, the average weight loss was 17.5%.

Effects Similar to Bariatric Surgery

Lilly said, “We think this is a major breakthrough in obesity treatment; it is the only drug that can lose an average of more than 20% of body weight in phase III clinical trials. The effect is similar to bariatric surgery, without invasive procedures and There is no risk of surgical complications. In phase III clinical trials, an average of 20% of body weight was lost.”

Differences among weight-loss drugs

Like Wegovy and Mounjaro, Eli Lilly’s retatrutide is injected once a week and changes the way patients eat by mimicking certain hormones in the gut, resulting in decreased appetite.

But Wegovy mimics only one hunger-regulating hormone called GLP-1, while Mounjaro mimics both GLP-1 and another hormone called GIP. Retatutide mimics three different hunger-regulating hormones: GLP-1, GIP, and glucagon, which may have a greater impact on a person’s appetite and satisfaction with food.

Oral administration can expand the market

Advantages of the oral route

BMO Capital Markets analyst Evan David Seigerman estimates that weight-loss drugs in pill form may account for about 15% of the total market, and he predicts global annual sales will reach 100 billion yuan in the next few years.

Physicians and analysts say weight-loss drugs in pill form are unlikely to outperform current weekly injections for weight loss, given the chemical composition, and some pills may be even worse, and some are less effective than daily pills, physicians and analysts say. Patients may prefer the convenience of a weekly injection.

However, experts also pointed out that if the price of weight-loss pills is lower, it may attract some patients.

Well-known weight loss oral drugs

According to the mid-term clinical trial results released by Eli Lilly on 6/23/2023, overweight or obese patients who took Orforglipron once a day lost 14.7% of their body weight after 36 weeks. Lilly said that the drug trial met its initial goals.

Doctors usually prefer a once-daily pill like Orforglipron to Danuglipron twice a day. Based on convenience, tolerability, and magnitude of weight loss, Orforglipron may be a better choice.

Side effects

Food industry has taken a hit

The popularity of new weight-loss drugs from Novo Nordisk and Eli Lilly in the United States has begun to have an impact on the traditional food and beverage industry. On October 5, 2023, Coca-Cola and Pepsi, the two major beverage giants in the United States, plunged 4.83% and 5.22% respectively, with their market values evaporating by US$11.5 billion and US$12.13 billion in one trading day.

Prior to this, Walmart also issued a warning that consumers taking new diet pills from Novo Nordisk and Eli Lilly and Company, which have caused major changes in the U.S. food industry, have reduced shopping demand.

Celebrity push

In Hollywood, tech circles and celebrity circles, weight loss drugs have become a major talking point when talking about weight loss and thinning. Tesla CEO Musk, who was previously ridiculed by netizens for being too fat and needing to lose weight, tweeted in October 2022 that he lost 9 kilograms in one month. The secret is regular fasting and using Wegovy.

Market value of related companies has skyrocketed

After Wegovy was approved for listing in 2022, the market demand was strong, and Novo Nordisk’s stock price rose by 50% in the following year, making Novo Nordisk’s P/E 70% higher than its peers. Also because of incretin, the current stock price of Eli Lilly is about US$442, and the price-to-earnings ratio is twice that of its peers. In the past year, the market value of these two companies has rapidly squeezed into the top five listed pharmaceutical companies in the world.

Note: Inspired by Eli Lilly’s announcement of its second-quarter financial report on August 8, 2023, the performance of new drugs exceeded expectations, its stock price soared by 14%, and its market value surpassed Johnson & Johnson to become the world’s most valuable listed pharmaceutical company again.

On August 8, 2023, the market value of Novo Nordisk even approached that of LVMH (ticker: LVMHF), which has the largest market value in Europe.

ticker	6/2/2023 share price	Stock performance in past 1 year	P/E	Market value (US$ billion)	Dividend yield
ABBV	136.87	-6.59%	32.39	241.48	4.33%
AMGN	218.07	-11.15%	14.81	116.52	3.91%
GSK	34.28	-21.34%	3.79	70.49	4.07%
JNJ	156.97	-11.01%	32.84	407.92	3.03%
LLY	442.33	45.81%	70.22	419.89	1.02%
MRK	112.5	25.24%	21.96	285.51	2.60%
NVO	157.14	40.12%	40.65	270.65	1.12%
PFE	38.36	-27.98%	7.56	216.55	4.28%
REGN	739.95	21.50%	20.11	81.18	0.00%
RHHBY	40.21	-2.47%	19.02	262.94	0.00%
RYTM	17.34	413.61%	0	0.987	0.00%
PPH(VanEck Pharmaceutical ETF)	76.7	-1.86%	18.52	0.397	1.80%
S&P 500	4,282.37	3.90%	18.52	35,002	1.80%

Table 2: Stock price performance of companies related to weight loss (figures from Google Finance and Yahoo Finance)

Related drugs are in short supply

Because it is regarded as a miracle drug for weight loss by people who are keen on weight loss, it will start to prevent diabetic patients who really need it from buying the drug in 2023. Diabetics in the U.S. say it takes them hours to find a nearby pharmacy that stocks the prescription drug; patients have even had to reduce their dose or switch to an alternative.

Drug shortages make it harder for diabetics to keep blood sugar levels low, increasing the risk of complications such as kidney and blood vessel damage; the same is happening in Europe and China. The European Medicines Agency stated in March 2023 that related drugs will face a long-term shortage and will continue throughout 2023, and it is uncertain when it will improve; doctors are required to give priority to diabetes rather than weight loss.

New indications discovered

The amazing GLP-1

The most encouraging thing about the miraculous GLP-1 is that these new generation GLP-1 weight loss drugs have been found to have many new indications, which is exciting news for patients and investors. More than one clinical medical report pointed out that the effects of GLP-1 drugs are not limited to the field of weight loss, but are also effective in kidney disease, heart disease, sleep apnea, etc.

Shanxianda make people smarter

Obese people have abnormal metabolism and hormones, which will cause abnormal operation of brain neural circuits and reduce learning ability. Recently, German scientists discovered that a single dose of the weight-loss drug “Senfid” (the main ingredient is Liraglutide, note) can restore the insulin function and learning ability of obese people to normal. The findings were published in the journal Nature Metabolism in August.

Ozempic helps quit addiction

Many users have found that diabetes drugs such as Ozempic not only help them lose weight, but also help them overcome overeating or alcohol or smoking addiction. So, could these diabetes medications serve as an alternative to withdrawal treatment for addictive behaviors? What are their active ingredients? How will it affect the brain? Can the effect last? Daniela Hernandez of The Wall Street Journal explains the above questions by combining scientific principles and experimental findings.

Risk

Potential self-harm side effects

Europe’s drug safety regulator is reviewing Ozempic after reports of suicidal thoughts linked to the popular weight-loss drug and another drug in its class. The European Medicines Agency said on July 10, 2023 that it was assessing the safety risks of patients taking this type of drug produced by Novo Nordisk after learning that three users of the drug reported self-harm or suicidal thoughts.

Regain lost weight within a year of stopping the drug

Novo Nordisk clinical trials showed that patients who stopped taking the drug regained most of the lost weight within a year. In March this year, Novo Nordisk stated at a health summit: “The available data show that most people regain most of their body weight within five years of stopping Wegovy and about 50% of their weight after two to three years. weight.”

Regulatory advice

GLP-1 drugs have recently been hailed by the market as a “magic drug for weight loss”, but the European Medicines Agency (EMA) has recently poured cold water on it. In May of this year, EMA issued a drug safety risk recommendation. The EMA raised a thyroid cancer safety signal for products including the GLP-1 target for diabetes and obesity drugs. This is a way of monitoring potential adverse events of approved drugs.

Obvious side effects

A client who is engaged in the medical aesthetics industry received an injection of semaglutide, “I have almost no appetite after the injection, and I don’t want to eat anything, and I feel overwhelmed after taking a small bite.” After the injection, there will be reactions such as lethargy and wanting to drink water all the time. Deng Zhidong, general manager of Hainan Boao Medical Technology Co., Ltd., said that most of the weight loss drugs on the market are side effects of weight loss, rather than direct weight loss drugs, so the effect is often not satisfactory.

Unlike those who tried their best to find medicines, another client had an injection as prescribed by the doctor because of his high BMI. The initial dose was 0.25mg, but severe gastrointestinal reactions occurred after adding 0.5mg. “While losing weight quickly, you were actually dehydrated and couldn’t concentrate at work at all.”

Potential Risks

In October 2023, a study published in the Journal of the American Medical Association also stated that weight loss drugs such as Wegovy and Ozempic may increase the risk of gastric paralysis, pancreatitis, intestinal obstruction, and biliary tract disease in non-diabetic patients . Please note: Since weight loss drugs such as Wegovy and Ozempic are new generation drugs, the potential risks are still unknown. More medical reports and larger-scale actual clinical results are needed to obtain safer and more accurate confirmation.

I am the author of the original text, and the condensed version of this article was originally published in Smart magazine.

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