The weight loss wars get heavier

For squeamish friends who want to lose weight without a weekly jab, Novo has a solution: Put down the needle and pick up a pill.

In a study presented today, participants who switched from either Novo’s Wegovy injection or Eli Lilly’s Zepbound to the daily Wegovy pill continued to lose weight, shedding another 4.1% of their body weight, or about 8.8 pounds, on average over three months. The findings are some of the earliest real-world evidence that patients can switch from injectable weight loss drugs to oral semaglutide without giving up their progress, suggesting they may not have to sacrifice results for convenience.

That’s welcome news for Novo, whose shares are down 26% this year—and sank again last week after investors came away underwhelmed by its long-term growth plans. Regardless, the stock dropped 1.04% today.

Turning up the doses

In the other corner of the weight loss drug market, Eli Lilly is also trying to give patients something they can’t already get.

The drugmaker’s experimental EloraTZP treatment combines tirzepatide—the active ingredient in Zepbound—with eloralintide, a drug that mimics another hormone that helps people feel full called amylin (it’s also a potential competitor to Novo’s CagriSema, which combines drugs targeting amylin and GLP-1). It’s being developed partly for patients who don’t lose as much weight as they’d like on today’s drugs—and the results were resounding.

In a mid-stage trial, the highest dose of the combination produced an average weight loss of a whopping 23.3% after 48 weeks, compared with 14.8% for the highest dose of tirzepatide alone. But it’s no free lunch: Gastrointestinal side effects were more common, and as many as 27% of patients in some combination groups dropped out, versus 2.9% on tirzepatide alone.

That dropout rate isn’t exactly ideal for a treatment meant to be taken long-term, which may help explain why shares remained largely flat today. The stock is still up 7.87% this year.

Choose your fighter

Novo and Lilly are increasingly placing different bets on what the next generation of the weight loss market will look like.

Novo is betting on a growing group of consumers who want a less invasive approach. While injectables still dominate today, CEO Mike Doustdar thinks pills could eventually capture as much as half of the global obesity drug market by 2030, well above Wall Street estimates of 14% to 40%. Oral drugs already account for about one-third of US obesity prescriptions, and Novo has captured more than 80% of new oral prescriptions.

That could give the roughly $130 billion drugmaker another way to close some of the widening gap with Lilly, now worth more than $1 trillion.

Lilly, meanwhile, is betting there are plenty of patients who care more about squeezing out every extra ounce they can.

Either way, as scales lighten, the stakes for Novo and Lilly will only get bigger.—SY