Topline
Competition is heating up in the race to crack the lucrative weight-loss drug market as rivals like Roche, Eli Lilly, Novo Nordisk and Pfizer develop oral drugs that help people lose weight without injection, a boon in the fight against obesity but a milestone for experts say it faces obstacles and is unlikely to completely eliminate the need for shots.
Pharmaceutical companies such as Lilly, Roche and Pfizer are rushing to develop slimming pills.
Key facts
Blockbuster injections such as Ozempic, Wegovy, Mounjaro and Zepbound – brand names for the drugs semaglutide and tirzepatide – belong to the booming class of drugs known as GLP-1 agonists, which mimic the action of a hormone involved in regulate blood sugar levels and appetite, called glucagon-like peptide-1.
Drugs made from peptides and proteins – which are essentially very large peptides – are almost always given as injections, because they are easily broken down by enzymes in the intestines and do not easily enter the bloodstream, especially if they are large.
“Unless you can prevent the breakdown process and also improve absorption of the protein, you have obstacles to achieving useful drug levels,” University of Toronto endocrinologist Daniel Drucker told Forbes, adding that “99% of all protein therapies” such as insulin are injectable.
While it may be a challenge to find a formulation that works as well as an injectable, it can be done, as Novo already markets Rybelsus, a pill form of semaglutide – the drug in Wegovy and Ozempic – for diabetes and companies like Lilly and Pfizer are making progress in small molecule GLP-1 agonists, such as orforglipron and danuglipron, which can be administered orally and appear to rival the weight loss achieved with injections already on the market. be a market.
Director of West Virginia University’s medical weight management program, Laura Davisson, told Forbes that weight-loss pills may not be right for everyone, explaining that compliance tends to decrease with the frequency of doses, especially if taken more than once per day. day should be taken. day – and that dietary restrictions, such as having to take it on an empty stomach, can further reduce a drug’s appeal.
Ultimately, “some people may prefer a weekly dose, even if it is injectable,” says Eduardo Grunvald, professor and director of the weight management program at University of California San Diego Health.
Will oral weight loss medications replace injectable medications?
Clinical trial data suggest that oral drugs compare favorably with injected weight loss drugs and may provide a similar degree of weight loss with a similar range of side effects. It is possible that companies developing them could opt for lower rates of weight loss to reduce side effects, or for dosing schedules of more than once per day required to overcome the difficulties of getting the drug into the bloodstream. Even if a pill is less effective at achieving weight loss than available injectables, it will still find a market. “We need all the tools we can get to treat obesity,” Davisson said, adding: “A drug that has a unique property, such as taking it orally, would still be useful even if it is less effective in terms of weight. then lose an injectable GLP1 drug.†Oral medications also eliminate many of the negative effects associated with injectable medications. Injector pins, for example, can increase production costs and often require refrigeration, which can limit access. While many patients don’t mind injection pens, Stanford endocrinologist Sun Kim told Forbes, “Injections can be very intimidating for other patients,” and these patients could benefit from an oral option.
When will weight loss pills be available?
Weight loss pills will likely be years away, given the lengthy process of drug testing.
Ozempic and Wegovy maker Novo Nordisk is leading the way when it comes to bringing an oral weight-loss drug to market. The Danish giant is the maker of the only authorized oral GLP-1 drug, Rybelsus, and has a significant first-mover advantage when it comes to gaining approval for another condition. New cannot start the drug as a slimming pill without jeopardizing its leading position with its diabetes and weight loss bestsellers Ozempic and Wegovy. Rybelsus is simply an oral formulation of the same drug, semaglutide, and the company is already failing to produce enough to meet demand. The problem is compounded by dosage, with the oral version requiring much more of the active ingredient than its injectable counterpart. Novo has already delayed asking regulators to approve the drug for weight loss and is conducting clinical trials to test a lower-dose version with less semaglutide. Lilly and Pfizer are both working on promising once-a-day pills, orforglipron and danugliprone, and Roche has touted promising results from two candidates in early-stage trials.
Tangent
Weight loss pills can also help overcome the often overlooked environmental impact of injectable medications, Kim said. “I am concerned about the environmental waste associated with injection therapies. “Many of the GLP-1 medications use one ‘pen’ for one dose of medication injected weekly,” Kim explained. “That’s 52 pens wasted and dumped into the environment! Hopefully newer formulations can be aware of how we can reduce this waste.â€
Chief critic
“Oral medications would be much cheaper for patients and I think it would make less money for the companies that make them,” said Shauna Levy, an obesity medicine specialist at Tulane University School of Medicine. She added that companies have already “proven that they can make an effective” oral version of GLP-1 drugs. “I think this is one of the main reasons why they are not currently pushing for oral semaglutide and saving all the semaglutide from injectable medications.”
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