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Revolutionary New Drugs (Ozempic, Wegovy) Treat Obesity, Diabetes and Addiction, Business and Industry Trends Analysis

     Weight loss products and services constitute a multi-billion-dollar industry worldwide, but the money expended often leads to disappointing results.  In the U.S., for example, the Centers for Disease Control (CDC) estimated that 41.9% of all adults over the age of 20 were obese during the 2017-2020 period.  (Obese indicates a body mass index. or BMI, of 30 or more, compared a range of 18.5 to 24.9 BMI for normal weight bodies, depending on height.)
     Weight loss, particularly for the obese, may well provide the next massive, worldwide revenues boost for the pharmaceuticals industry.  Earlier drugs in this channel work by reducing the absorption of food in the digestive tract.  The previous generation of drugs include Saxenda from Novo Nordisk; Contrave, a combination of bupropion-naltrexone from Orexigen and Takeda; and Alli from Roche’s Xenical.
     However, there are exciting next-generation drugs which show great promise in treating obesity and related diseases.  The key is the use of these drugs to act as a “GLP-1 receptor agonist.”  That is, they work by acting like a hormone that occurs naturally, known as GLP-1.  (GLP stands for glucagon-like peptide.)  The result is an increase in the feeling of being full and a corresponding reduction in appetite.  For example, a person may feel quite full and satisfied with a small portion of pasta while on the drugs, who in the past might have had a compulsion to eat two or three large servings.
     These drugs are also known to be effective in treatment of type 2 diabetes (GLP-1 receptors are also involved in the release of insulin).  While many patients have achieved very significant weight loss with the drugs, they do have some drawbacks.  They are expensive. (These drugs cost roughly $900 to $1,350 monthly in the U.S., although independent “compounding” pharmacies may be able to sell equivalent, non-branded versions for much less.)  Also, current versions require injections, although oral versions are likely to be launched.  Side effects can include gastrointestinal problems such as vomiting and nausea.  These limitations have to be considered alongside the fact that obesity is a condition that can lead to cardiovascular problems, diabetes, joint problems and many other life-limiting or life-threatening conditions, that in addition are extremely expensive to combat.  In 2020, the Milken Institute, a non-profit group focused on advanced pharmaceuticals and health care research, estimated the combined economic and social impact of obesity (including such factors as missed days at work and reduced household income), to be $1.4 trillion yearly in the U.S. alone.  A Swedish study found that people who are obese are three times more likely to receive disability payments and have twice as many sick days as non-obese people. 

Breakthrough Obesity Drugs Wegovy and Zepbound
The drugs which have received FDA approval for obesity therapy include Novo Nordisk’s Semaglutide (under the brand name Wegovy).  (This firm’s Ozempic was approved as a drug for Type 2 Diabetes but was also used by some obesity patients.)  Tirzepatide (under the brand name Mounjaro) was approved as a diabetes drug but was used by many patients as a weight loss drug.  It is likely to be replaced for weight loss users by the newer, obesity specific Zepbound, which was released in December 2023.  Both Mounjaro and Zepbound are from Eli Lilly.  

     Various estimates place the global annual market for such drugs at $50 billion to $100 billion, making this field of extreme interest to pharmaceutical manufacturers.  Eli Lilly’s Zepbound is considered by some analysts likely to become the highest grossing drug in history.  If insurer coverage can be widely obtained, oral versions developed and ways to better control side effects can be found, annual sales could soar beyond today’s estimates.  The fact that ancillary benefits to the resulting weight loss are being proven, such as the reduction of stroke risk, could provide even more potential to this market.  Also, of great importance is the fact that these GLP-1 agonists may have tremendous promise in the control of compulsive disorders or serious addictions, such as alcohol or drugs.  
Zepbound combines GLP-1 therapy with a gut hormone called glucose-dependent insulinotropic polypeptide (GIP), in order to help lower blood sugar and possibly increase metabolism.  Trial data has been extremely supportive.  One trial found that Zepbound helped patients to lose up to nearly 21% of their weight in 72 weeks, while Wegovy achieved nearly 15% at 68 weeks.  Eli Lilly is also experimenting with adding glucagon to Zepbound, a hormone that can increase the number of calories that are burned.  In one study, this triple combination enabled patients to lose almost 33% of their weight in 48 weeks.
Many challenges remain for these drugs and their manufacturers.  Getting full agreement from major insurers, including Medicaid, Medicare and private insurance, is a big obstacle.  Meanwhile, demand is so high that manufacturers have had difficulty in maintaining sufficient supply.  (Novo Nordisk acquired a New Jersey-based contract manufacturer called Catalent, Inc. in early 2024, significantly expanding its capacity.)  Side effects such as nausea, along with the fact that some patients are not happy with the prospect of giving themselves shots are also challenges, on top of the expense to patients.  Nonetheless, patients in general are having great success with these drugs, reporting weight loss, fewer food cravings significantly greater ease in feeling full after much smaller amounts of food.  The future is very likely extremely bright for this sector, particularly when you consider the widespread incidence of obesity and the numerous, devasting diseases fueled by too much weight, including heart problems and diabetes.

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