Ozempic and Wegovy have revolutionized the landscape of obesity treatment, becoming two of the most rapidly-selling drugs in history. However, their appeal is dampened by undesirable side effects and the need for injections. Pharmaceutical companies are now in a race to develop a new generation of obesity medications in pill form. These easy-to-take tablets have the potential to be even more profitable than the injectable versions, which have already generated billions in profits for drug makers. Novo Nordisk, Eli Lilly, and Pfizer are among the contenders striving to be the first to release a highly effective, safe, and lucrative weight loss pill.
The availability of these pills, their effectiveness, and potential downsides are the pressing questions that Dailymail.com seeks to answer. Wegovy, marketed as Semaglutide, will be accessible at pharmacies starting from the spring. Ozempic and Wegovy work by stimulating the production of glucagon-like peptide-1, a hormone naturally released from the intestines after meals.
Three major players in the pharmaceutical industry are competing to develop pill versions of their injectable weight loss medications. Novo Nordisk holds the lead with their oral semaglutide, which is the same active ingredient found in Ozempic and Wegovy shots. Novo’s once-daily pill is similar to their type 2 diabetes drug, Rybelsus, which contains a low dose of semaglutide. Eli Lilly is also a key player, having achieved success with their drug tirzepatide, branded as Mounjaro. They are currently testing an oral version called orforglipron, which has been found to help individuals lose up to 15 percent of their body weight. Pfizer, on the other hand, discontinued one of its obesity medicine candidates due to potential liver damage, but they continue to conduct trials for another drug called danuglipron, which has not shown any liver damage thus far.
The next iterations of Ozempic and Wegovy pills would function similarly to their injectable counterparts. The active ingredient, semaglutide, promotes weight loss by mimicking the actions of the hormone GLP-1 in the brain, which regulates appetite and feelings of satiety. However, instead of requiring patients to administer weekly injections, the semaglutide pill would be taken daily on an empty stomach. Lilly’s orforglipron, on the other hand, is a glucagon-like peptide-1 receptor agonist (GLP-1RA) that activates hormones regulating blood sugar, digestion, and appetite.
The timeline for accessing pill versions of Wegovy and Ozempic remains uncertain at this point, although Novo Nordisk appears to be leading the way. The Danish company recently announced their plans to seek FDA approval in the US and EU in 2023. Although semaglutide is already available in pill form for individuals with type 2 diabetes under the brand name Rybelsus, the current dosages are too low to effectively result in weight loss. The extent of the medication’s benefits remains to be seen, considering that drugs in this class are expensive and often not covered by insurance. Dr. Shauna Levy, an obesity medicine specialist from Tulane University, emphasizes the importance of having multiple treatment options for patients suffering from obesity.
Novo Nordisk has unveiled the results of two clinical trials demonstrating the efficacy of semaglutide pills, which were considered highly exciting by Dr. Levy. The Phase 3 OASIS 1 trial evaluated the semaglutide pill in individuals with overweight or obesity but without diabetes. Over a period of 68 weeks, 667 participants were tracked, with half receiving a daily 50mg dose and the other half receiving a placebo. The group taking the pill experienced an average weight loss of 15 percent (around 35 lbs) at the end of the trial, compared to roughly 2.4 percent in the placebo group. These results indicate that the oral version of the drug is just as effective as the injectable 2.4mg dose of Wegovy, which can successfully reduce up to 15 percent of a person’s body weight. Another trial, named the Phase 3 PIONEER PLUS trial, specifically tested the pill’s effectiveness in individuals with type 2 diabetes. Patients receiving daily doses of 14mg, 25mg, or 50mg saw greater improvements in blood glucose levels and greater reductions in body weight. Patients taking the higher doses lost between 15 and 21 lbs after 68 weeks, while those on the low dose lost an average of 10 lbs. Lilly’s mid-stage trial also showed positive results, with the highest dose of orforglipron helping obese or overweight individuals lose between 9.4 and 14.7 percent of their body weight after 36 weeks.
However, the pills do come with downsides. The infamous side effects associated with Wegovy and Ozempic injections, such as severe diarrhea, constipation, and gastrointestinal issues, persist even in pill form. Around 13 percent of patients experienced tingling or altered skin sensation, which generally resolved after several weeks. The side effects become more severe with higher doses, as seen in Novo’s trials. In the Pioneer trial, 80 percent of patients on the 50mg dose reported adverse effects, compared to 79 percent in the 25mg group and 76 percent in the 14mg group. Gastrointestinal issues were the most common adverse effects, and 13 percent of users on the 50mg dose discontinued the medication due to discomfort. The Oasis trial for obese patients without diabetes revealed that 80 percent experienced mild to moderate gastrointestinal issues, including vomiting, nausea, constipation, or diarrhea. Around 6 percent of trial participants chose to stop taking the drug before the trial ended due to these side effects.
Nearly 40 percent of American adults are obese, making them eligible for the injectable obesity medications. The majority of people are projected to be overweight by 2030, further expanding the multi-billion-dollar market. While these drugs are popular, with millions of prescriptions being filled in 2022 alone, the introduction of pill forms would be a major relief for those who fear needles. However, it’s important to note that the benefits of these medications may not be accessible to everyone, considering their high cost and limited insurance coverage. Obesity medicine experts stress the importance of individualized treatment options for patients, as obesity is a chronic and progressive disease.
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