According to Bloomberg, analysts believe securing broad reimbursement and supply are key, with possible upside from further innovations including combination products. In addition, competitive dynamics could mirror those seen in diabetes.
“We expect Novo Nordisk's franchise (Wegovy, Saxenda, oral semaglutide, CagriSema) and Eli Lilly's tirzepatide to dominate with shares of 54% and 46% respectively, while contributions from less-effective AOBs are negligible,” said Michael Shah, senior industry analyst at Bloomberg Intelligence.
“Pipeline developments such as oral GLP-1s by Lilly and Pfizer, and Amgen and Lilly's dual- and triple-combination drugs represent upside to our view.”
Bloomberg Intelligence’s model only includes approved drugs and those in ongoing phase 3 trials. Using marketed treatments as a proxy, Bloomberg is expecting ex-US markets to have a 30-40% contribution within five years of launch. For Europe, BI has assumed a slower ramp and a 20% price discount to the US.
Anti-obesity drugs target an addressable population of about 140 million people in the US, which is 3 times higher than that of type 2 diabetes.
GLP-1 penetration rates in obesity are low, with the sales potential of medicines such as Novo Nordisk's Wegovy and Eli Lilly's tirzepatide ultimately hinging on the level of reimbursement secured in what has traditionally been an out-of-pocket market.
Bloomberg argues that broad access could represent “significant upside” with swing factors including price and patient stay times, which might also be influenced by insurer policies.
Supply will also be key with both drugmakers investing to expand manufacturing capacity in light of strong demand, the report says.
Despite obesity affecting 650 million people globally, only 2-3% are medically treated and costs associated with the disease exceed $2 trillion.
“Unprecedented demand in obesity coupled with the strong relaunch of Wegovy, which serves as a benchmark for future launches, underpins our upgraded sales view for the market. Our previous scenario, published in early February, called for $28 billion in obesity sales in 2030, or $33 billion if we don't adjust for clinical failure risk,” Shah adds.
“Since that analysis, Novo raised its full-year guidance on strong uptake for Wegovy and also expanded supply capacity, which will ultimately determine sales levels for the GLP-1 amid strong demand, at least in the near term.
“Our raised view for oral semaglutide 50 mg is underpinned by solid weight loss data and results from our survey of 100 US-based prescribers, which was conducted in March and highlighted a clear need for oral therapies.”