The obesity drug race moves beyond weight loss
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The obesity-drug race is becoming less about losing weight and more about keeping it off.
Why it matters: As more GLP-1 drugs deliver eye-popping results, the next winners may be determined by convenience, affordability and whether patients keep taking them long enough to benefit.
- That means reducing side effects, focusing on lifestyle changes and making the pricey drugs affordable.
- "Keeping the weight off is going to be the next big challenge," said Tim Blackstock of Citeline, a biopharma intelligence services firm.
Driving the news: Eli Lilly recently said its experimental drug retatrutide reduced body weight by an average of nearly 30% after 80 weeks — approaching the levels of bariatric surgery.
- But with existing pills and injectables already delivering up to 20% weight loss, clinicians and market analysts are questioning how much is enough — and whether the benefits of more powerful drugs outweigh the risks.
- "Everybody was chasing after that number — weight-loss magnitude," William Blair analyst Andy Hsieh told Axios. Now, the question is: "Is an additional 3% weight loss worth significantly more GI toxicity?"
- "There are many consumers who do not need to lose more than 15% of their body weight," Leerink analyst David Risinger told Axios.
Deciding who should be on which GLP-1 is becoming more complicated, said Wei-Li Shao, president of digital diabetes and obesity care management company Omada Health.
- Beyond having unpleasant gastrointestinal side effects, GLP-1s can weaken muscles, cause loss of bone mass and increase gallbladder problems in those experiencing rapid weight loss.
- "The more effective these drugs become, the more important nutritional support, lifestyle support, muscle preservation support becomes," Shao said. "The risk scales with the increased outcomes."
To keep patients on the drugs and achieve long-term benefits, companies including Amgen, Viking Therapeutics and GLP-1 giants Lilly and Novo Nordisk are increasingly betting on new approaches like combination therapies to improve tolerability or make treatments easier to take over the long term.
- "With so many different pharmaceutical companies kind of getting in on the game, they're all trying to find their own niche," Chris Weber, a board member of the Obesity Medicine Association, told Axios.
- The stakes have risen as GLP-1s demonstrate benefits beyond weight loss.
- "It really started with the SELECT trial for Wegovy" that showed decreased risk of major cardiac events, stroke and other risks, Weber said. "We're not just lowering the number on the scale. We're preventing deaths."
What to watch: How Lilly prices retatrutide once it's approved could determine whether it becomes a premium product for patients who need the most weight loss or a broader option for patients using lower doses.
- The company declined to comment on pricing strategy. "The goal here is to reach a lot of people, and we'll do what we need to do to ensure that that happens," said Lilly executive vice president Ken Custer.
The bottom line: After making it all about the numbers, drugmakers' next challenge may be helping patients find the right drugs — and stay on them long enough for the weight loss to matter.
