Wegovy and Zepbound are Just the Start
The front runners in this high-growth market are established, but the battle for market share is just getting started.
Source: Evaluate Pharma© (May 2024)
Note: Sales are predominantly in diabetes (purple) and obesity (blue) but by 2028 will include MASH, chronic kidney disease and chronic heart failure.
The front runners in this high-growth market are established, but the battle for market share is just getting started
The obesity therapy market is still in its early innings. Wegovy and Zepbound together sold less than $5 billion in 2023 – a fraction of the $130 billion Evaluate estimate for the overall GLP-1 space by 2030. The battle for market share has barely begun, and, by the end of the decade, there will likely be more than two in the fight.
Sales of frontrunner Wegovy (semaglutide), a household name barely three years post-launch, are expected to triple over the next five years. Yet it has already been trumped, efficacy-wise, by Eli Lilly’s Zepbound (tirzepatide) and other development candidates; three of the top ten most valuable pipeline products are obesity drugs, topped by Novo’s own Phase 3 combo Cagrisema.
Zepbound’s extraordinary forecast annualised average growth rate between 2023-2030 – over 90% - is in large part due to its lower baseline: Lilly launched in late 2023, more than 18 months behind Wegovy. The drug has also shown slightly stronger weight loss data than Wegovy, likely because it hits not only glucagon-like peptide (GLP)-1, as Wegovy does, but also agonises an additional weight-loss related hormone, GIP (glucose dependent insulinotropic peptide).
But Novo has laid down the gauntlet. When Zepbound arrived, the Danish group launched its Phase 3 head-to-head pitting next-in-line Cagrisema against the highest dose of the Lilly drug. Cagrisema combines long-acting amylin analogue cagrilintide with semaglutide, adding another mechanism that may further potentiate weight loss. In Phase 2, the combination led to 15.6% average weight loss at 32 weeks – possibly faster loss than Zepbound which, at 72 weeks, generated an average 20.9% loss at its highest dose. The drug’s net present value of almost $80 billion makes it the most valuable pipeline candidate. (See Figure 7)
Other Big Pharma like AstraZeneca are buying into the gold rush, and investors are busy writing cheques for next-generation innovators. Going forward, precise percentages shed – even once in-trial comparisons are available – may be less important than route of administration or dosing frequency. Wegovy and Zepbound are once-weekly injections. Many clinicians are excited by the prospect of Lilly’s oral GLP-1 orforglipron, silver medalist in the most valuable pipeline projects by net present value. Amgen’s Phase 2 MariTide may offer a once-monthly injectable option that’s more tolerable. The antibody-peptide conjugate activates GLP-1 and blocks (rather than activates) GIP. Other development candidates seek to improve the quality of weight loss – fat more than muscle – and/or to maintain loss after treatment has ceased.
