5 questions facing pharma in 2024

The arrival of powerful new drugs for obesity has reshaped the pharmaceutical industry, transforming Eli Lilly and Novo Nordisk into the sector’s most valuable companies and sending others scrambling to catch up.

Analysts predict that so-called GLP-1 drugs like Lilly’s Zepbound and Novo’s Ozempic will become some of the most lucrative products ever sold. Their benefits appear to extend beyond weight loss and blood sugar control, too, raising the possibility they may also change how obesity is treated.

This year should help answer whether any other companies can break Lilly and Novo’s duopoly. A similar dynamic is playing out in oncology, where drugmakers are competing against Merck & Co.’s and Bristol Myers Squibb’s recent dominance.

Other storylines in drug pricing, Alzheimer’s and next-generation manufacturing figure to be important as well. Read on for five of the most important questions facing pharma in 2024:

Can anyone challenge Novo and Lilly in obesity?

Nordisk and Lilly had a big head start developing drugs based around the gut hormone GLP-1 for diabetes and, later, weight loss. Ozempic, Novo’s weekly GLP-1 for blood sugar control used off-label in obesity, has become a popular culture shorthand for weight loss treatment. Lilly, meanwhile, has an answer to Novo with its newly approved Zepbound, which also targets another hormone receptor called GIP.

With the GLP-1 drug market expected to reach as high as $90 billion a year, other companies are eager to compete and perhaps even surpass the two leaders. Among them are large pharmaceutical companies like Pfizer, Amgen and Boehringer Ingelheim, as well as smaller biotechs like Zealand Pharma and Kallyope. To have a chance, aspiring developers will need to improve on the weaknesses of Ozempic — sold as Wegvoy for weight loss — and Zepbound.

Chief among them is the drugs’ under-the-skin injection method of delivery. Novo has a GLP-1 diabetes pill called Rybelsus, which has also shown it can deliver weight loss in non-diabetic people who are obese. Lilly has sped development of a drug called orforglipron, while Pfizer has stumbled developing two rival pills.

Another way to best the incumbents could be by reducing side effects like nausea and vomiting, which are substantial. In the SELECT trial that showed Wegovy can protect heart health, 17% of participants stopped taking it because of adverse events, twice as many as the dropout rate in the control group.

A third approach to beating the on-market GLP-1s may involve preserving lean body mass like muscle. Patients in Wegovy’s clinical trials lost healthy lean body mass as well as fat. A drug that helps people retain muscle tissue could improve their metabolic health and prevent complications like diabetes.

Outperforming on cardiovascular benefits would be the surest, but most time-consuming and expensive strategy. While GLP-1 drugs have sparked a shift in how obesity is treated, insurers are still focused on whether treatment can prevent hospitalization or heart complications. Wegovy has set the benchmark by reducing the relative risk of heart attacks, stroke and death by 20%. Lilly could have data later this year.

With the recent rush of R&D investment, many would-be competitors could soon hit key mid- and late-stage trial milestones that determine whether their drugs work and have a chance commercially. A shakeout of obesity projects wouldn’t be surprising as the year progresses. — Jonathan Gardner

Merck and Bristol Myers have dominated cancer immunotherapy. Who wins oncology’s next era?

Merck’s Keytruda and Bristol Myers’ Opdivo have dominated the cancer treatment conversation for a decade. Both will reach the end of their patent-protected monopolies as soon as 2028 in the U.S., pushing the two drugmakers to explore commonly used ways of extending market exclusivity, like combination treatment and formulation changes.

Leave a Reply

Your email address will not be published. Required fields are marked *