On January 26, the website of the National Medical Products Administration showed that the marketing application for Novo Nordisk's developed and produced Novo X (semaglutide tablets) has been approved for the treatment of type 2 diabetes. This is the world’s first and only oral glucagon-like peptide-1 receptor agonist, which means that GLP-1RA class drugs have entered the oral era, making medication more convenient.

In fact, in the highly anticipated weight loss field, the "competition" for GLP-1 receptor agonists has already begun.

The competition mainly remains in the weight loss field.

Semaglutide Tablets Approved for Adult Type 2 Diabetes, Only One Tablet Needed Per Day; Novo Nordisk to Announce Pricing Post-launch. Public information indicates that in Europe and the U.S., the drug (packaged in 30 tablets) is priced at $935.77 USD across multiple dosages (3mg/7mg/14mg) without insurance reimbursement. Based on this, each tablet costs approximately RMB 224.

Semaglutide is the second-generation GLP-1 receptor agonist developed by Novo Nordisk. In April 2021, the semaglutide injection was approved in China for the treatment of adult type 2 diabetes and to reduce the risk of cardiovascular adverse events in patients with type 2 diabetes and cardiovascular disease.

In June 2021, the weight management indication of semaglutide was approved by the U.S. Food and Drug Administration (FDA) for market release, making it the first once-weekly GLP-1 receptor agonist for weight management. Clinical studies have shown that after 12 weeks of once-weekly subcutaneous injection of semaglutide, patients in the 2.4mg dose group who were obese or overweight experienced an average weight loss of approximately 6%; at 68 weeks, the weight loss reached 17%-18%. As a result, semaglutide has been dubbed a "miracle weight-loss drug."

The approval of the weight-loss indication directly boosted the sales of semaglutide. In 2022, the drug's sales reached $10.9 billion, and in the first three quarters of 2023, with the support of the weight-loss indication, the cumulative sales of three semaglutide products reached $14.282 billion.

The soaring sales have made semaglutide a strong contender for the title of the world's "top drug." The previous "top drug," Humira, has largely stepped down from its position in 2023 due to factors such as patent expiration. Merck's "K drug" (Keytruda), which has long been eyeing the "top drug" spot, raked in $18.403 billion in the first three quarters of last year. From this, it is not difficult to see that although there is still a certain gap between semaglutide and Keytruda in terms of sales, the growth rate of semaglutide is also impressive.

Throughout 2023, according to incomplete statistics by reporters, Novo Nordisk has invested approximately 59.5 billion Danish kroner (77.662 billion yuan) in multiple instances to expand the production capacity of semaglutide, ensuring product supply.

Tirzepatide Brings Considerable Pressure

While semaglutide sales are booming, it is also under pressure from its long-time rival, Eli Lilly and Company.

On November 8, 2023, Eli Lilly's tirzepatide (brand name Zepbound) received FDA approval for the indication of obesity or overweight. Results from a Phase III clinical trial published by Eli Lilly in October 2023 showed that tirzepatide demonstrated superior weight loss effects compared to semaglutide. Following a 12-week intensive lifestyle intervention (low-calorie diet, exercise, and medical counseling), participants treated with tirzepatide for 72 weeks—totaling 84 weeks—experienced an average weight reduction of 26.6% among non-diabetic obese/overweight subjects.

In June last year, Eli Lilly and Company also announced that the Phase II clinical trial data of the experimental drug Retatrutide, a GLP-1 triple agonist, showed that at 24 weeks, Retatrutide (1mg, 4mg, 8mg, or 12mg) met the primary endpoint for efficacy evaluation in participants who were obese or overweight without diabetes, with an average weight loss of 17.5%. For the secondary endpoint, the average weight loss was 24.2% at the end of 48 weeks of treatment.

Although it did not gain the first-mover advantage in drug launches, Eli Lilly is still pulling out all the stops. After tirzepatide was approved for weight loss indications, Eli Lilly was the first to initiate a "price war," pricing tirzepatide 20% lower than semaglutide. To make it more convenient for patients to access the medication, on January 4 this year, Eli Lilly announced the launch of a new website, LillyDirect, which allows patients to obtain prescriptions for weight-loss drugs and diabetes medications through telehealth providers. The platform also offers home delivery of medications. Eli Lilly stated that LillyDirect will make it easier for patients to access these drugs without having to visit a doctor for a prescription and then go to a pharmacy to fill it.

Eli Lilly's tirzepatide will also become a strong contender for the "best-selling drug" in the coming years. Data and analytics firm GlobalData believes that superior clinical data on weight loss efficacy will enable tirzepatide to surpass semaglutide, becoming the top-selling drug in the obesity and diabetes market, with projected sales reaching $27 billion by 2029. This figure is clearly impactful for both Keytruda and semaglutide.

Reporter Zhang Xiulan from The Beijing News

Proofread by Wang Xin