Drugmakers race to develop next obesity drugs

Drugmakers are racing to shape the next chapter of obesity treatment as competition intensifies. Just months after introducing GLP-1 pills, companies are already outlining plans for new drugs, less frequent dosing, and alternatives to current therapies. At the American Diabetes Association’s Scientific Sessions in New Orleans, executives from Eli Lilly and Novo Nordisk highlighted their latest innovations, including pills and experimental triple-acting drugs. Both firms emphasized that oral options are expanding access, with Novo reporting over 3 million Wegovy prescriptions within five months of launch.

Lilly and Novo dominate the market, but a wave of new entrants is emerging. Structure Therapeutics and AstraZeneca shared mid-stage data for their GLP-1 pills, which could reach the market by 2029. Structure’s CEO, Ray Stevens, argued that even as a second small molecule drug, there’s room for multiple players.

Some companies are exploring beyond GLP-1. Zealand Pharma, collaborating with Roche, presented mid-stage data for petrelintide, an amylin-targeting drug that reduced body weight by nearly 11%—slightly less than existing options but with fewer side effects. CEO Adam Steensberg compared the potential launch to an “iPhone moment,” where a new modality could shift patient preferences. Lilly, meanwhile, is advancing its own amylin drug, eloralintide, in Phase 3 trials.

Lilly’s retatrutide, a triple agonist drug, showed dramatic results in Phase 3 trials. At the highest dose, participants lost an average of 28% of their body weight. CEO David Ricks said the drug could help people with severe obesity achieve healthier weights, a goal not always met by Lilly’s current offering, Zepbound. “Almost half of participants lost more than 30% of their weight,” he said, highlighting the drug’s potential.

Investors are debating whether the market will remain a duopoly between Lilly and Novo or open to new players. With 2.5 billion overweight and 890 million obese people globally, demand is vast. Goldman Sachs analyst Asad Haider called pricing the key question. Both Lilly and Novo have cut prices on their shots, competing against generic versions sold by compounding pharmacies. They’re also pushing for better insurance coverage, including a $50 monthly co-pay for Medicare beneficiaries.

Novo’s CEO, Mike Doustdar, sees obesity evolving like mental health, with distinct treatments for different severities. “Today, mental health includes depression, bipolar, and schizophrenia,” he said. “Obesity will be the same.” With so many drugs in development, the future of obesity treatment could look very different from today’s setting. For now, companies are betting on their innovations to capture a growing market.