First-Mover Advantage: Novo Nordisk and Eli Lilly Have at Least Four-Year Monopoly Periods Ahead

Since its approval in June 2021, the obesity treatment market has undergone a significant transformation. Wegovy, as a GLP-1 medication, has achieved tremendous success. Its effectiveness surpasses that of previously marketed weight-loss drugs, and it is also considered safer.

According to Barclays' predictions, there is still enormous growth potential in the global GLP-1 drug market, with an estimated value of over $100 billion by 2030. Based on the current situation, Novartis and Eli Lilly are expected to dominate the majority of the market in the coming years.

GLP-1 medications are primarily used for two main indications: weight loss and type 2 diabetes (T2D). According to the World Obesity Federation, the number of overweight or obese individuals is expected to reach a staggering 4 billion by 2035. However, currently, only Wegovy and Saxenda have been approved for the treatment of obesity, so the market is still in its early stages.

In the T2D market, the penetration rate of GLP-1 medications is still low, with approximately 10-12% of T2D patients in the United States using these drugs. There is significant room for growth, and it is projected that by 2030, around 35% of diabetes patients in the United States will be using GLP-1 medications, considering that about 65% of T2D patients also have obesity issues. Due to the perceived standard treatment efficacy of GLP-1 medications in blood sugar control and weight reduction, along with their cardiovascular benefits, it is expected that these medications will continue to be rapidly adopted.

In terms of FDA-approved prescription drugs for long-term weight loss treatment, there are currently six main options: Wegovy, Saxenda, Belviq, Contrave, Qsymia, and Xenical. Among these, Wegovy and Saxenda belong to Novo Nordisk. Wegovy, in particular, has a significantly higher total prescription volume compared to others.

Wegovy, (Novo Nordisk, Semaglutide),injectable. Wegovy has shown the ability to reduce weight by 15% after 68 weeks of treatment.

Saxenda, (Novo Nordisk, Liraglutide),injectable. It is administered once daily, but its efficacy is not as significant as Wegovy.

In terms of diabetes indications, Novo Nordisk's Ozempic leads in sales. It's worth mentioning that both Ozempic and Eli Lilly's Mounjaro are used off-label for weight loss. Similar to Wegovy, Ozempic is also a semaglutide product of Novo Nordisk, but there are differences in terms of activity and other aspects.

Eli Lilly's Mounjaro currently has indications for Type 2 Diabetes and has not yet been approved for weight loss. It is expected to receive approvals in the EU, America, and the UK by the end of this year.

Key Products:

Ozempic:(Novo Nordisk, Semaglutide), injectable, once weekly. It has a weight loss effect similar to Wegovy.

Rybelsus: (Novo Nordisk, Semaglutide), oral tablet (3mg, 7mg, and 14mg), approved as an adjunct to diet and exercise for improving blood glucose in adults with Type 2 Diabetes.

Mounjaro:(Eli Lilly, Tirzepatide), injectable, once weekly. Mounjaro has an advantage over Wegovy in terms of weight loss, with the potential for up to a 20% reduction in body weight.

Trulicity:(Eli Lilly, dulaglutide), injectable, once weekly. It can be used in adults with Type 2 Diabetes who have cardiovascular (CV) disease or multiple CV risk factors to reduce the risk of non-fatal stroke.

Other products have significant disadvantages in terms of weight loss and glucose reduction, making it difficult to compete with these two major players.

GLP-1 has shown a reduction of 14% in stroke and heart attacks among diabetes patients, a 12% reduction in deaths for various reasons, and an 11% reduction in hospitalizations due to heart disease. Novo Nordisk's SELECT CVOT trial for cardiovascular disease patients and Eli Lilly's SUMMIT trial have yielded positive results, which are expected to bring about a transformation in the treatment of cardiovascular disease and further support growth.

Orforglipron: It is an oral, small molecule drug. It is estimated that Orforglipron will achieve approximately 14% to 15% weight loss after a 36-week treatment. The plan is to submit applications in 2025 and 2026.

Retatrutide: It is an injectable drug and a triple G receptor agonist that targets GLP-1, GIPR, and amylin. At the highest dose, it is estimated to result in approximately 22% to 24% weight loss within 48 weeks. The submission/approval timeline may be around 2026/2027.

CagriSema: It is an injectable drug that combines semaglutide with a long-acting amylin analog called cagrilintide. Novo Nordisk aims for weight loss of over 25% with CagriSema. It is expected to enter the US market in 2025 and achieve a market share of 35% by 2030.

High-dose Rybelsus: It is an oral drug containing semaglutide. The high-dose version of Rybelsus (50 mg) can lead to approximately 14-15% weight loss in obese patients. It is expected to be launched in 2025.

According to the "Ten Years, Ten Billion Dollars" rule of drug development, the process from research and development to market approval for this type of drug is lengthy. Other competitors such as Pfizer are also accelerating their research and clinical trials, but the disclosed results currently show no significant advantage. Moreover, their clinical trials are still in the early stages, making it difficult for them to replace the products of Lilly and Novo in the short term. According to J.P. Morgan's forecast, these products are expected to enter the market around 2026, capturing a small portion of the market share.

Pfizer's key product :Danuglipron (oral PF-06882961): This drug is taken orally twice daily, and the average weight reduction rate in small-scale clinical trials is approximately 8.5%. Phase 2 data will be announced in the first quarter of 24. The time for market entry may be late.

Forward-looking research by AmgenAMG 133: A dual-specific GIPR antagonist and GLP-1 receptor agonist molecule. Clinical results show an overall weight reduction of 14.5% in the high-dose group after three months.

AMG-133 is administered once a month, which may provide an advantage in this regard. However, the impact of this conjugate on blood glucose in diabetic patients will also be closely monitored, as GIP antagonists may even worsen diabetes. More evidence is needed to demonstrate its safety and efficacy.