挑战与趋势

Obesity:TheNextQuestions Before the incretin drug class provedits potential to prompt dramaticweight loss, the notion that obesitycould be treated with a pill orinjection was almost science fiction.Decades of research had yieldedapproaches with meagre efficacy orunacceptable safety, banishing thefew medicines that made it to marketto commercial obscurity. Obesity:The Next Questions Solid proof thatpharmacologicalintervention can helpshift excess body weightnow exists. Three incretin agentshave won obesity approvals and areselling strongly, leveraging themechanisms of the metabolichormones that they mimic. NovoNordisk’s GLP-1 agonists Saxenda(liraglutide) and Wegovy(semaglutide), and Eli Lilly’sZepbound (tirzepatide), whichagonises a second incretin target,GIP, as well as GLP-1. These drugsare also sold under different brandnames in type 2 diabetes. might cost to catch up. What level ofinvestment will clinical programmesrequire? What might an acquisition cost?And what are the chances of success forfollow-on agents, with similar or perhapsnovel mechanisms? Developers and investors are no longerasking ‘can obesity be effectively treatedpharmacologically?’. The burning questionnow is ‘how big could the marketbecome?’. Evaluate Pharma’s consensusforecasts, constructed from sellsideanalysts’ models, has the obesity markethitting $66bn by 2030. Projections that gofurther out have that number goingconsiderably higher. Want access to the infographic aswell? Download here. This short report attempts to startanswering these questions, using EvaluateOmnium data. Using machine learning toanalyse millions of data points, EvaluateOmnium allows clients to gain powerfulvisibility into the commercial potential anddevelopment risks of pharmaceuticalassets at all phases of development. Formore in-depth information on Omnium’smodels, please see the end of this reportor speak to a member of the team. Other unknowns include how longpatients might stay on these drugs, anissue that those involved in pricing andreimbursement are very keen to explore. Those hoping to follow Novo and Lilly onto the market are asking how much it The MarketSizeQuestion Just how big would this marketbecome? Obesity is a sizeable marketand co-morbidities could push itmuch higher. The Market SizeQuestion It is widely accepted thatobesity is causing majorproblems in Westerncountries and is a growingconcern for many less developedregions. Epidemiology data over a20-year period show ballooningrates of obesity in the US and thefive largest European economies –the United Kingdom, Germany,France, Italy and Spain. The epidemiology data in this reportfocuses on this six-county region. Thehigh price of these new obesity drugsmeans that these rich countries,particularly the US, will drive much of theirdemand. straight weight loss is behind some of thereally big numbers being attached to thisdrug mechanism. Excess body weight isassociated with multiple co-morbidities, and much work is underway to prove thatthat these drugs can help conditions likesleep apnoea, chronic kidney disease andosteoarthritis. Obesity is a sizeable market in itself,however the incretins’ potential beyond Phase 3 trials in these and other relatedmetabolic and cardiovascular settingsrepresent some of biopharma’s mostanticipated readouts, and not onlybecause they could reinforce incretins’broad utility. Success will help push openthe doors of payers, many of which arereluctant to cover these expensive drugsfor weight loss alone. include the FLOW trial of semaglutide inpeople with type 2 diabetes and chronickidney disease, which was stopped earlyfor efficacy, and tirzepatide’s performancein SYNERGY-NASH, in patients with liverdisease. Many financial analysts believe that theincretins, across all uses, could becomebiopharma’s first drug class to hit annualsales of $100bn. Some estimate thatfigure could end up closer to $200bn. Thisis a huge prediction when considering the$67bn peak annual sales projection for thenext most successful drug class, anti-PD-(L)1 antibodies, a group of cancercheckpoint inhibitors led by Merck & Co’sKeytruda. Incretin analogues are already wellestablished – and selling billions – in type2 diabetes, the disease for which theseagents were initially developed. Accordingto Evaluate Omnium, 83% of patients withtype 2 diabetes also have obesity andoverweight. Evaluate Omnium’s epidemiology dataallows this disease crossover to bemapped, with the below chart showingfive co-morbidities; many more exist. That $100bn year is not that far away,Evaluate Pharma’s forecasts reveal. It isimportant to remember that these hugeprojections include incretin sales made inall settings, not just obesity. For now, thatmeans type 2 diabetes. Studies in adjacent conditions remain awork in progress, but a handful of wins arefuelling big thinking. Notable successes The graph below shows sales of incretindrugs (all uses) against obesity marketsales. The obesity market is most