Eli Lilly and Novo Nordisk are building a case for both old and new incretin drugs as attractive weight loss maintenance options and options that can help you lose weight more quickly, respectively.
The companies’ new data set, which focuses on both Lilly and Novo’s respective obesity injectables Zepbound (tirzepatide) and Wigovy (semaglutide), as well as the companies’ new oral drugs Foundayo (orforglipron) and Wigovy tablets, was presented earlier this week at the European Obesity Congress’ annual meeting in Turkey.
Regarding the original dosing format, Lilly evaluated the potential of a lower 5 mg Zepbound dose to help patients maintain weight loss for one year after taking the maximum dose of the GIP/GLP-1 agonist. The Indianapolis drugmaker also considered Foundayo’s potential in the same setting, including patients switching from Novo’s own Wegovy.
Meanwhile, Novo took the opposite approach with its results for its injectable Wegovy, highlighting the strength of its newly FDA-approved high-dose shot in a subanalysis of its Step Up trial, allowing patients to achieve faster and greater weight loss than previously seen at its highest strength.
At the same time, Novo announced similar “early response” results for its Wegovy tablets. It has seen impressive uptake since beating Lilly’s Foundayo in the US market at the beginning of the year.
Novo’s data could help the company’s Obesity range regain its lead over Lilly, which has overtaken its rival in the U.S. despite being second to market after Zepbound and its type 2 diabetes product, Munjaro.
Meanwhile, Lilly’s data address a key concern in the broader GLP-1 class: whether patients can maintain weight loss after treatment with high-dose incretins. Some industry watchers have suggested that oral GLP-1 may play this role.
Lilly’s Thermount Maintain study crunched the numbers and found that doses as low as 5 mg of Zepbound helped patients maintain weight loss after the first 60 weeks of treatment at maximum doses of 10 or 15 mg.
Specifically, patients who switched to a lower dose of the injectable drug regained their average weight from 196.2 pounds after the highest escalating dose to about 208.6 pounds after 52 weeks into the maintenance treatment period, Lilly said, noting that the results utilized an efficacy estimation method that discounts outcomes for patients who did not adequately adhere to the treatment plan.
Lilly also highlighted data that was first released in December. The data found that patients taking the company’s obesity drug Foundayo for maintenance purposes gained about 5 kg (11 lb) when switching from the company’s Zepbound and 0.9 kg (about 2 lb) when switching from Novo’s Wegovy.
“Obesity is a chronic disease that requires long-term treatment, and patients need more options that can sustain their treatment over time,” Dr. Kenneth Custer, Lilly’s vice president and president of cardiometabolic health, said in a statement Tuesday.
He added that Lilly is “committed to providing multiple treatment options for people on their weight loss journey.”
Novo’s Wego strikes back
For Novo, the company is touting the impressive and rapid weight loss potential of its new high-dose (HD) 7.2 mg injectable Wegovy format, which was given the green light in the US in March.
In a partial analysis of the Step Up program comparing Wegovy’s highest dose to date, 2.4 mg, to the HD format over 72 weeks in obese adults without type 2 diabetes, approximately 27% of patients who received 7.2 mg were classified by Novo as “early responders,” meaning they lost 15% or more of their body weight within the first 24 weeks of treatment. Additionally, that early response group lost an average of about 28% of their body weight at 72 weeks, exceeding the approximately 21% weight loss standard for which the HD injection won FDA approval.
By comparison, about 21% of patients who received the highest dose of Wegovy to date and 3% of patients who received a placebo fell into the early responder group.
The Danish drugmaker also published early responder data on the oral Wegovy option, noting that nearly one-third of patients given the 25 mg semaglutide pill in the Oasis 4 clinical trial lost an average of 13.2% of their weight after four months, for a total average weight loss of 21.6% at the end of the study, which lasted 64 weeks.
In addition, data from a separate Oasis 4 analysis found that Wegovy tablets helped improve activities such as range of motion and stamina in “8 out of 10” people in the study with inadequate physical performance charts, and produced weight loss results similar to the overall oral Wegovy cohort, Novo said.
“Things that many people take for granted, such as the ability to stand for long periods of time or simply bend over, can all be affected by excess weight,” Novo’s chief scientist Martin Hossl Lange explained in a statement. “These analyzes of our trial data deepen our understanding of the broader benefits of the Wegovy pill and reaffirm its best-in-class efficacy, tolerability and safety profile.”
Novo is now leading Lilly on the newly unleashed oral obesity front, and both companies are deploying competitive data.
In the first three months of this year, Novo reported that Wegovy tablets generated approximately 2.26 billion Danish kroner (approximately $355 million). Jamie Miller, Novo’s vice president of U.S. operations, said on a conference call last week that as of April 17, a total of about 2 million Wegovy oral prescriptions had been written in the United States.
Regarding Foundayo, Lilly’s obesity tablets have generated approximately 7,335 total prescriptions in the four weeks since its launch on April 9, Citi analysts wrote to customers last week, citing IQVIA’s prescription statistics.
On paper, its rollout appears slower than Novo’s, but the tracking of Lilly’s drug launches (Lily said on its first-quarter earnings call that it reached about 20,000 patients) may not adequately account for a significant amount of Foundayo’s telemedicine prescriptions, Cititeam said.
