“In twenty years I have never seen anything like it. These new treatments represent a true game changer for the industry. We are facing a spring of pharmacological revolution.”
This is how endocrinologist Cristóbal Morales, member of the Spanish Obesity Society (SEEDO) and one of the Spanish experts who is contributing the most internationally to the clinical development of anti-obesity drugs, which aspire to be blockbusters or bestsellers, speaks from Seville. of the coming years for the pharmaceutical industry.
The two main ones are called Wegovy (from Novo Nordisk) and Zepbound (from Eli Lilly). “Everything indicates that these products will be the best sellers of all time in the pharmaceutical sector,” said Seamus Fernández, an analyst at the Guggenheim Securities brokerage. On an economic level, “the only drug with which they can be compared is Viagra,” Professor Kurt Jacobsen, from the Copenhagen Business School (CBS), told the BBC.
Denmark is precisely the country of Novo Nordisk, the company that has become the largest in Europe by market capitalization, even ahead of LVMH. According to some sources, the firm, which today is worth close to 400,000 million euros, already represents almost 2% of the GDP growth of the Scandinavian country. Its shares remain near all-time highs.
Rund Sand-Holm, portfolio manager of the DNB Healthcare Fund, says that “the market currently estimates sales growth of around 180% for Eli Lilly and around 130% for Novo Nordisk between now and 2030, but we believe that “The consensus may still be too cautious regarding the growth potential of anti-obesity drugs.” Both stocks have quadrupled in three years and this year alone they have registered a combined increase of 180,000 million.
We are talking about a market, that of obesity, that can reach 100,000 million euros by the end of the decade, according to market sources. Goldman Sachs predicts that up to 70 million Americans, where obesity is a social plague, will take medications to reduce their body mass by 2028.
There are more overweight people in the world (1.2 billion) than people suffering from famine, according to data from the World Health Organization. The number of obese people exceeds 650 million adults, to which we should add the group of children who suffer from childhood obesity (and in which Spain stands out worldwide). Obesity has tripled on the planet in the last 50 years.
The World Obesity Atlas 2023 report draws a disturbing picture: the economic cost of overweight and obesity will reach 4 trillion euros per year in 2035, a figure that is four times the Spanish GDP, since half of the world’s population will suffer from excess weight. Whoever manages to find the solution to this problem will find a treasure.
And there they go: these two drugs offer weight loss that ranges between 15 and 20% over time. They derive from research that was designed to cure diabetes. But tests showed that the principle behind the molecules allowed them to mimic a hormone, called GLP-1, increasing the feeling of satiety with a corresponding reduction in appetite.
Future versions could even raise these percentages, by also acting on the way sugars and fats are burned. Their effectiveness is proven and they can take over surgery, which is much more invasive. Currently, an injection is required to deliver them, but several manufacturers are already testing a pill. In addition, in the case of Zepbound, other positive effects on sleep apnea or circulation are being studied.
A new treatment studied by Novo Nordisk could be twice as effective against obesity as its successful drugs Ozempic (the version for diabetes) and Wegovy, according to very preliminary results from the laboratory. Thanks to the hormone amicretin, weight loss reached 13% in three months, double that of the rest of the drugs on the market.
Therefore, it is not surprising that beyond these two giants, other companies are jumping in to eat the economic pie of obesity. The most advanced are the American Viking Therapeutics and the Danish Zealand Pharma. The latter has signed a cooperation agreement with Boehringer Ingelheim. Both firms have products that are good candidates and that are undergoing clinical trials.
Altimmune (whose shares have grown 140% in three months), as well as Structure Therapeutics, are in the trial phase. Amgen is another possible player, as is Astra Zeneca (it has signed a licensing agreement with the Chinese biotech Eccogene) and Roche, which has recently acquired the pharmaceutical company Carmot Therapeutics for 2.5 billion euros, to set foot in this market. In turn, Pfizer says it will soon have a pill that will have similar effects to the drugs already sold.
Since research needs time (and money), it is difficult for the reign of Eli Lilly and Novo Nordisk to be altered before the next five years. But the pie is big and there is probably enough food for everyone.
Geoff Meacham, of Bank of America, one of the most reputable analysts in the health sector on Wall Street, predicts that Eli Lilly alone with its best-selling drug Zepbound will earn more than 55 billion euros by 2030, which would represent double the total of the company’s turnover in 2023.
However, there are no miracle drugs and from an economic point of view the road may still be bumpy. To begin with, there are supply and shortage problems. Companies cannot produce sufficient volumes to meet demand, which is crazy. To do this, Novo Nordisk will acquire the American manufacturer Catalent for more than 15 billion euros to avoid bottlenecks. “We are not at all happy with our current production capacity,” declared Eli Lilly’s chief executive, David Ricks.
Another unknown is the cost of the medication. We are talking about very expensive treatments. A dose for one month in the United States can cost 1,200 euros. Businessman Elon Musk, one of the richest men in the world, has publicly admitted that he uses Wegovy “to stay in shape.”
A message, however, that is somewhat dangerous. Not only because money is not a problem for him, but it is also not a drug that can be consumed lightly (regardless of possible side effects). According to a study by Imperial College London published in The Lancet magazine, “the high cost and poor accessibility of these drugs will accentuate inequality.”
“We must distinguish between overweight and obesity. The second is a chronic pathology, normally with a body mass index greater than 30, which requires treatment practically all of life. The health system in Western countries usually covers and takes care of obesity, but not excess weight. These drugs, very successful, require a medical prescription in any case. Recreational consumption with the aim of reducing weight or improving your figure is neither possible nor desirable,” warns Dr. Cristóbal Morales.
A recent OECD study estimates that one in four citizens in Western countries is severely overweight, with an impact of 3.5% on the GDP of all the member states of this organization. OECD countries allocate 8.4% of their health budget to obesity (9.9% in Spain).
The Wegowy has been approved by the European Medicines Agency (EMA) in 2022 and is available in the United Kingdom and Germany. The other brands will arrive soon. Spain is in it. “From now on the negotiations begin. With the European approval already obtained, it is just a question of price and seeing what part is in charge of the public system. It cannot be compared with the United States, where the private insurance lobby is very powerful,” explains a senior manager of a pharmaceutical company in Barcelona. “In Europe you can pay up to ten times less in some cases, but distributors also want their share of profits,” she says. The hunger to make money is truly insatiable.