Novo Nordisk and Lilly are leading the charge in the high-growth obesity drug market with their blockbuster drugs recording multi-billion sales growth in the first half of 2024, a trajectory expected to continue for the full year 2024. What are leading drug candidates from other bio/pharma majors?

By Patricia Van Arnum, Editorial Director, DCAT, pvanarnum@dcat.org

The battle of the blockbusters
Glucagon-like peptide 1 (GLP-1) agonists, which can be used to treat Type 2 diabetes and obesity, are a rising class of blockbuster drugs (defined as drugs with sales of $1 billion or more). GLP-1 agonists work by promoting insulin secretion, which helps maintain blood sugar levels in patients with Type 2 diabetes. This class of drugs also may promote weight loss by reducing appetite and delay gastric emptying, thereby leading to reduced food intake.

Leading the charge in the GLP-1 market are Eli Lilly and Company and Novo Nordisk, each with blockbusters in this drug class. Sales of Lilly’s Mounjaro (tirzepatide), for treating Type 2 diabetes, reached $5.16 billion in 2023 and first-half 2024 sales already have reached $4.90 billion. Mounjaro was approved in the US for treating Type 2 diabetes in 2022, and in November 2023, the same active ingredient, tirzepatide, was approved in the US for treating chronic weight management under the brand name, Zepbound. Following its approval in November 2023, Zepbound has already achieved blockbuster status with first-half 2024 sales of $1.76 billion.

Novo Nordisk has several GLP-1-based products for treating Type 2 diabetes: Ozempic (semaglutide, injection), Rybelsus (semaglutide, tablets), and Victoza (liraglutide). Combined, these drug posted 2023 sales of DKK 123.13 billion ($17.7 billion), a 48% gain over 2022, as measured in Danish kroner, and by 52% at constant exchange rates. Ozempic accounted for the lion’s share of these sales with 2023 sales of DKK 95.72 billion ($13.8 billion), and Rybelsus accounted for sales of DKK 18.75 billion ($2.7 billion).

Combined 2023 sales of two obesity-care GLP-1 products by Novo Nordisk, Wegovy (semaglutide) and Saxenda (liraglutide), were DKK 41.63 billion ($6.0 billion). Wegovy has the same active ingredient, semaglutide, as Ozempic and Rybelsus, and Saxenda, the same active ingredient as Victoza.

In the first-half of 2024, that positive sales growth trajectory has continued. Sales within Novo Nordisk’s diabetes and obesity care market increased by 26% in Danish kroner to DKK 125.0 billion ($18.3 billion) (27% at constant exchange rates), mainly driven by GLP-1 diabetes sales growth of 32% in Danish kroner (32% at constant exchange rates) and obesity care growing by 37% in Danish kroner to DKK 24.9 billion ($3.6 billion) (37% at constant exchange rates).

Market outlook for GLP-1 drugs, including obesity indications
The GLP-1 agonist market is poised for strong growth, with a compound annual growth rate (CAGR) of 19.2% from 2023 to 2029, reaching a market size of $105 billion in 2029, according to estimates (as of March 6, 2024) by GlobalData, a market research and business intelligence firm. It points to five key drugs: Lilly’s Mounjaro and four drugs by Novo Nordisk—Ozempic, Wegovy, CagriSema (semaglutide and cagrilintide) (now in late-stage development), and Rybelsus—which collectively are forecast to capture 83% of the GLP-1 agonist market by 2029. Eli Lilly’s Mounjaro is expected to lead in sales, with projected 2029 sales of $33.4 billion, according to estimates by GlobalData.  With a large portfolio of products of GLP-1 drugs, Novo Nordisk is expected to capture 55% of the GLP-1 market in 2029.

Longer-term growth projections in seven major markets (US, France, Germany, Italy, Spain, UK, and Japan) are even stronger. With the obesity and Type 2 diabetes markets growing at strong rates, the GLP-1 receptor agonists market is also growing. GLP-1 receptor agonist sales for the Type 2 diabetes and obesity markets are forecast to reach over $125 billion in these seven major markets in 2033, according to GlobalData (estimates as reported in May 2024).  

“There are currently 10 GLP-1 receptor agonists approved for Type 2 diabetes and three for obesity, but many more are expected to reach the market in the next five to 10 years,” said Costanza Alciati, Pharma Analyst at GlobalData, in commenting on the May 2024 data from the firm. “Indeed, there are 51 products in clinical development for obesity and/or Type 2 diabetes, which exploit the GLP-1 receptor agonist mechanism, often coupled with other actions. At present, Ozempic (Wegovy for obesity) and Mounjaro dominate the GLP-1 receptor agonist space. But there is an opportunity for new players to join the race as the market is vast. Some of the therapies in Phase III are very promising, and GlobalData expects them to reach the billion-dollar sales mark within a couple of years from their launch.”

The rise of Lilly’s and Novo Nordisk’s GLP-1 drugs has given new life to the market for obesity drugs overall. Novo Nordisk’s Wegovy and Eli Lilly’s Mounjaro generated $9.7 billion globally in 2023, which represented a 239% increase from the total revenue generated from all obesity drugs in 2022, according to information from GlobalData. Starting in 2024, significant increases in the number of launches of new obesity drugs are expected per year, culminating in a peak of four launches in both 2027 and 2028, according to estimates by GlobalData. Novo Nordisk is looking to cement its position as an obesity front-runner, as it will account for six of the 13 estimated launches. Its lead pipeline drug, CagriSema (semaglutide and cagrilintide), is currently in Phase III development for obesity. This product is expected to launch in the US by the end of 2025, and is forecast to generate $7.4 billion in revenue by 2029, according to estimates from GlobalData.

Pipeline contenders
In looking at the obesity drug market specifically, Novo Nordisk, Lilly, and other large bio/pharma companies are advancing drug candidates for treating obesity and related metabolic indications with various mechanisms of action. Some key pipeline contenders in both early and late-stage development noted by analysts include: Novo Nordisk’s monlunabant, amycretin, and INV-202 ; Lilly’s eloralintide, retatrutide, and orforglipron as well as bimagrumab (acquired through Lilly’s $1.9-billion acquisition of Versanis Bio in 2023); Pfizer’s danuglipron; Boehringer Ingelheim’s and Zealand Pharma’s survodutide; and Amgen’s MariTide (maridebart cafraglutide).

Interest in the obesity drug market is also engendering recent deal-making. In January (January 2024), Roche acquired Carmot Therapeutics, a Berkeley, California-based bio/pharmaceutical company, in a deal worth up to $3.1 billion ($2.7 billion at closing plus $400 million in potential milestone payments). The acquisition provides Roche with three clinical-stage assets with potential in treating obesity and diabetes. These include: (1) CT-388, a once-weekly subcutaneous injectable in Phase II, for treating obesity in patients with and without Type 2 diabetes; (2) CT-996, a once-daily oral small-molecule drug, in Phase I, for treating obesity in patients with and without Type 2 diabetes; and (3) CT-868, a once-daily subcutaneous injectable, in Phase II, for treating Type 1 diabetes patients with overweight or obesity. These drug candidates are incretins, which are gut hormones that are secreted after food intake and play a role in modulating blood glucose by stimulating insulin secretion and suppressing appetite. Roche says the incretin-based portfolio could also be expanded to other indications where incretins play a role, including cardiovascular, retinal, and neurodegenerative diseases.

Last November (November 2023), AstraZeneca formed a $2.0-billion pact ($185-million upfront and $1.825 billion in potential milestones) with Eccogene, a Shanghai, China-based clinical-stage bio/pharmaceutical company, for an exclusive license for Ecogene’s ECC5004, currently in Phase I, for treating obesity, Type-2 diabetes, and other cardiometabolic conditions.

Among other bio/pharma companies with key pipeline contenders in the obesity drug market noted by analysts include: Regeneron Pharmaceuticals’ trevogrumab; Altimmune’s pemvidutide; Innovent Biologics’ mazdutide; Viking Therapeutics’ VK-2735; and Structure Therapeutics’ GSBR-1290.