The US Food and Drug Administration’s approval gives drugmaker Novo Nordisk a competitive advantage over Eli Lilly in the race for an obesity pill. Lilly’s oral drug, orforglipron, remains under review.
Both medications are GLP-1 drugs that function similarly to popular injectables by mimicking a natural hormone that regulates appetite and fullness.
In recent years, Novo Nordisk’s Wegovy and Lilly’s Zepbound have transformed obesity treatment both globally and in the US, where 100 million people suffer from this chronic condition.
According to company officials, Wegovy pills should be available within weeks. The introduction of oral medications for obesity has the potential to broaden access and lower costs, thereby expanding the rapidly growing market for obesity treatments, experts suggest.
About 1 in 8 Americans have utilized injectable GLP-1 drugs, according to a KFF survey, a nonprofit health policy research organization. However, many struggle with the high cost of these injections.
Read more: Novo Nordisk introduces Ozempic in India for type 2 diabetes, priced to match Wegovy
“There’s a whole demographic that can benefit from the pills,” said Dr. Fatima Cody Stanford, an obesity specialist at Massachusetts General Hospital. “It’s not just about who finishes first; it’s about making these options available to patients.”
The Novo Nordisk obesity pill has 25 milligrams of semaglutide, the same ingredient found in Wegovy and Ozempic injectables, as well as Rybelsus, a lower-dose pill approved for diabetes treatment in 2019.
In a clinical trial, participants taking oral Wegovy lost an average of 13.6% of their total body weight over approximately 15 months, compared to a 2.2% loss with a placebo. This is nearly identical to the injectable Wegovy, which averaged around 15% weight loss.
Chris Mertens, a 35-year-old pediatric lung doctor from Menomonee Falls, Wisconsin, participated in the Novo Nordisk trial in 2022 and lost around 40 pounds using the Wegovy pill, noting that it helped reduce his appetite and intrusive thoughts about food.
“On days I missed a meal, I hardly even noticed,” Mertens remarked.
In separate trials, participants who received the highest dose of Lilly’s orforglipron experienced an average weight loss of 11.2% over nearly 17 months, compared to a 2.1% loss for those on a placebo.
Both oral medications yielded less weight loss than Lilly’s Zepbound (tirzepatide), which targets two gut hormones, GLP-1 and GIP, leading to an average weight loss of 21%.
All GLP-1 medications, whether oral or injectable, exhibit similar side effects, including nausea and diarrhea.
While both daily pills offer convenience, the Wegovy pill must be taken with a sip of water on an empty stomach in the morning, followed by a 30-minute wait before eating or drinking.
This design ensures the drug is not broken down in the stomach before being absorbed into the bloodstream. The drugmaker incorporated an ingredient that protects the medication for approximately 30 minutes in the gut, facilitating its effectiveness.
In contrast, Lilly’s orforglipron lacks such dosing restrictions. It is currently under consideration in the FDA’s new priority voucher program, which aims to expedite drug approval processes, with a decision expected by spring.
Read more: Emcure Pharma releases semaglutide-based weight management medication Poviztra in India
Generally, producing pills is less expensive than manufacturing injectable medications, suggesting that the cost of the new oral treatments may be lower. Earlier this year, the Trump administration indicated that officials had collaborated with drugmakers to negotiate lower prices for GLP-1 medications, which can exceed $1,000 monthly.
The initial monthly dose is expected to be priced at $149 from select providers, with further pricing information coming in January.
It remains uncertain whether patients will prefer daily pills or weekly injections. While some individuals are averse to needles, others have no issues with the weekly injections, according to obesity experts. Mertens switched to injectable Zepbound after regaining weight post-trial with the Wegovy pill.
He appreciated the structure that came with the daily pill routine.
“It provided me with an intentional routine, reminding me that I am taking this today, influencing my choices throughout the day,” he explained.
Dr. Angela Fitch, an obesity specialist and chief medical officer at knownwell, a healthcare organization, emphasized that regardless of the format, the main advantage lies in making weight-loss medications more accessible and affordable.
“Price is key,” she stated. “Just give me a drug at $100 a month that is relatively effective.”
