"In the works for people flocking to
Ozempic to shed lots of pounds: weight-loss medicines that come in a pill.
Drugs such as Ozempic that have
surged in popularity for weight loss must be injected. Yet many people despise
needles, prompting drugmakers to explore formulations that could be swallowed.
The chemistry isn't simple. But if
researchers can pull it off, the tablets could appeal to the sizable number of
people who fear needles, while costing hundreds of dollars less than their
injected cousins.
The hunt for tablet versions of the
injectable weight-loss medicines is among the hottest areas of drug research,
attracting industry heavyweights like Eli Lilly, Novo Nordisk and Pfizer and
fueled by a potential multibillion-dollar market.
Farthest along is a tablet form of
semaglutide -- a main ingredient in the injections -- developed by Novo
Nordisk.
The experimental pill helped people
who took it daily for 68 weeks as part of a study lose up to 17.4% of their
body weight, Novo Nordisk said in May. The reduction was similar to what
testing found for Ozempic's cousin, the drug Wegovy.
Later this year, Novo Nordisk plans
to ask U.S. and European drug regulators to approve the tablet.Novo sells a
tablet form of semaglutide, Rybelsus, to treat Type 2 diabetes, though some
people use it off-label for weight loss.
Novo Nordisk's Ozempic and Wegovy
therapies and Lilly's Mounjaro have emerged as viral sensations -- touted by
celebrities and discussed on Facebook and TikTok -- because of their potential
to help people lose significant weight.
These types of drugs, first approved
to treat diabetes, work by mimicking gut hormones that play a role regulating
blood sugar and, it turned out, appetite. A key gut hormone is called
glucagon-like peptide-1, or GLP-1.
Peptides are large molecules, which
are easier to package and deliver as an injection. Drugmakers have made their
GLP-1 drugs into injections so they avoid the journey of pills, which travel
through the digestive tract because they are swallowed. The digestive tract can
degrade peptides, minimizing their benefits.
But manufacturing the peptides and
the devices, known as pens, to inject them is expensive and complex.
Injectable drugs must be stored at
certain, often cold, temperatures. And they strike fear in a small but
significant group.
"Some people are just
needle-phobic,"said BMO Capital Markets analyst Evan David Seigerman.
Analysts project the anti-obesity
medicine market will be so large that drugmakers have launched efforts to find
tablets that would appeal to those who don't want to be injected.
Seigerman estimated that pill forms
of weight-loss drugs could make up about 15% of the total market, which he
predicts will reach $100 billion in annual sales worldwide in coming years.
Drugmakers have designed the oral
versions of the gut-hormone drugs to overcome digestive-tract degradation by
either using a higher dose than the injected drugs or by using a non-peptide
form of gut hormone.
Given the chemistry, pill forms
aren't likely to surpass the weight loss that can be achieved with the current
once-weekly injections, doctors and analysts said.
Some tablets might even deliver
inferior weight loss. And some patients might prefer the convenience of a
once-weekly injection over a daily pill.
"I'm just guessing people will
say, 'You know that once a week sounds much simpler,'" said Dr. Robert
Kushner, an obesity-treatment specialist at Northwestern University Feinberg
School of Medicine.
Yet the pills could prove attractive
to a segment of patients if priced less, according to analysts and doctors.
A pill being developed by Structure
Therapeutics could be priced at about $500 a month if it succeeds in testing
and is approved by regulators, Seigerman estimated, roughly half the cost of
the injected drugs.
Structure Chief Executive Raymond
Stevens said it was too early to discuss a specific price, but the company's
goal is to price the drug to make it accessible to patients.
"If these oral medications are
more affordable or more accessible, that could be where they could fill that
gap," said Dr. Ania Jastreboff, director of the Yale Obesity Research
Center in New Haven, Conn.
Eli Lilly is developing a
non-peptide GLP-1 pill called orforglipron.
The once-daily pill, taken for 36
weeks, helped volunteers lose up to 14.7% of their body weight in a mid-stage
clinical trial of more than 270 people with obesity, researchers reported
Friday at the annual meeting of the American Diabetes Association in San Diego.
That was a loss of about 35 pounds
for a person in the study who had the average starting weight of 240 pounds.
Lilly recently started a larger,
late-stage clinical trial of the pill, in hopes of generating sufficient
evidence for approval.
The company has said its GLP-1 pill
is unlikely to help people lose as much weight as its injected drug Mounjaro,
which adds a second gut hormone, GIP, to GLP-1.
In one study, patients taking
Mounjaro lost up to about 22.5% of their body weight.
If the experimental pill
can match the GLP-1-only injected drugs, however, it could be an option for
some patients.
Pfizer is developing anti-obesity
pills including danuglipron, which showed promise in a mid-stage study reported
earlier this year.
In testing, the pill versions of the
weight-loss injections come with similar gastrointestinal side effects such as
nausea for some patients.
The companies have said the events
are generally mild to moderate and typically occurred when doses were
increased." [1]
