Wegovy pill could deliver as much weight loss as the shot, trial shows

Eli Lilly and Novo Nordisk are vying for supremacy in the weight-loss market they dominate as they both race to get an obesity pill to market.

Novo Nordisk sought approval for its pill with the United States Food and Drug Administration earlier this year and expects the agency to conclude its review by the end of this year.

Eli Lilly said last month that it expects to seek approval of its weight-loss pill, orforglipron, this year. Also yesterday, Eli Lilly released initial results of a clinical trial comparing orforglipron with select doses of oral semaglutide, the active ingredient in Wegovy, saying that its weight-loss pill showed superior reductions in blood-sugar levels and weight. The trial evaluated 1698 adults with Type 2 diabetes.

Novo Nordisk tested a higher dose of semaglutide in its pill in its clinical trial, involving 307 adults who were overweight or obese.

The company said that even for participants who didn’t fully take it as directed, they still lost an average of 13.6% of their body weight, compared with 2.2% for those that got a placebo.

Nearly a third of participants who got the Wegovy pill lost at least 20% of their weight regardless of whether they took it exactly as intended, the company said.

In addition to losing weight, participants who got the drug also were able to be more active and improve their cardiovascular risk, Novo Nordisk said.

“Oral semaglutide looks a bit better for absolute weight reduction but it is harder to take appropriately,” said Angela Fitch, chief medical officer of knownwell and former president of the Obesity Medicine Association.

For one thing, oral semaglutide is supposed to be taken on an empty stomach. She said that orforglipron, which has no food or water restrictions, will likely be a better option for most people and “will become our first commodity drug for the most prevalent disease of our lifetime”.

Fitch has received payments from both Eli Lilly and Novo Nordisk.

A Novo Nordisk spokesperson said participants in its clinical trial for the Wegovy pill were instructed to wait 30 minutes before eating or drinking, and that it hasn’t seen evidence that patients stop taking the medication as a result of those guidelines.

Like the shot versions, the weight-loss pills come with significant side effects.

Novo Nordisk said nearly half of patients who got the Wegovy pill had nausea and nearly a third reported vomiting, though it described such reactions as “generally mild to moderate in severity and transient”.

About 7% of participants who got the Wegovy pill dropped out of the trial because of side effects, compared with 6% who got a placebo.

Eli Lilly said that about 10% of participants who received the highest dose of orforglipron dropped out of its trial over side effects, compared with 2.6% who got a placebo.

Even considering the side effects and potency of orforglipron, “it will still be a mega-blockbuster drug”, David Risinger, an analyst at Leerink Partners, wrote in a note to clients Wednesday, estimating that if approved the drug could fetch US$14b in sales in 2030.

Before decisions by the FDA, both Novo Nordisk and Eli Lilly are readying production for their weight-loss pills, having been unable to keep up with demand for their shots that exploded in popularity.

“Pending FDA approval, ample supply will be available to meet the expected US demand,” Martin Holst Lange, Novo Nordisk’s chief scientific officer, said in the company’s statement.

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