Obesity (obesity) is on the rise worldwide. Several promising new drugs are currently in trials or have already been approved and could make expensive stomach reduction procedures obsolete. Companies behind these potential blockbusters of tomorrow are worth a closer look, as are Covid-19 vaccine makers as the virus poses a much greater risk to obesity sufferers.
Exciting and growing healthcare market
There are currently over 764 million obese people worldwide, defined as having a body mass index (BMI) of over 30. BMI is calculated as a person’s weight divided by their height in meters squared. By 2030, over a billion people worldwide are expected to be obese. Obesity leads to a considerable subjective level of suffering in those affected, but above all it is also associated with multiple secondary diseases. Nevertheless, only around two percent of all those affected worldwide are currently being treated medically. So far, the area of obesity has hardly been developed and is a pronounced growth market.
Wegovy – a promising drug
Surgical stomach reductions for the treatment of obesity are successful and increasingly established. However, they represent an invasive procedure that is irreversible and entails lifelong controls. For this reason, drug treatment strategies were sought early on, which were often discontinued or even completely taken off the market because of their side effects.
So far, only drugs from diabetology, so-called GLP-1 receptor agonists, have become established. As a further development of the proven, but only moderately effective active ingredient liraglutide, there is now a high-dose semaglutide (under the product name Wegovy) from Novo Nordisk. Semaglutid has been tried and tested in diabetology worldwide for years in a lower dose under the product name Ozempic and is safe to use. Wegovy has been able to demonstrate weight reductions of over 15 percent in large studies and is already officially approved in the USA as a pure weight loss medication. Europe-wide approval was granted in early 2022. The demand for Wegovy is so high that Novo Nordisk cannot keep up with production. As a result, the lower-dose Ozempic (as an off-label use) is currently being used in part in the treatment of obesity.
Mounjaro by Eli Lilly with blockbuster potential
The active substance tirzepatid from the US pharmaceutical company Eli Lilly, as so-called twincretin, is initially a further development in diabetology, since it also addresses GIP receptors in addition to GLP-1.
The effects on blood sugar shown in studies exceeded those of pure GLP-1 receptor agonists. And the weight reductions were also impressive: With a weight loss of up to 22.5 percent, this substance not only surpasses all previously known drugs, but is also approaching a sound barrier as a drug for the first time, which was previously only known for stomach reduction.
In Europe, Eli Lilly is expecting approval by the end of the year, and from 2023 the syringe with the active ingredient tirzepatid could also be available in Germany under the product name Mounjaro for diabetes (type 2) on medical prescription. The drug has been on the market in the US for several months.
Tirzepatid is therefore considered one of the most promising new developments of recent years with high blockbuster potential. The outcome studies in diabetology, the actual tolerability and effect under “real-life” conditions remain to be seen. It will then be interesting to see whether tirzepatid will also be approved for the treatment of obesity alone. A decision is expected in 2023.
Win-win situation for those affected and payers
The global negative economic impact of obesity is estimated at around 3 percent of global GDP. The direct and indirect costs caused by obesity are thus estimated at over USD 900 billion annually.
The pressure is all the greater, not only on government payers, but also on those affected to reduce these costs. Drugs should only be used if no or insufficient weight loss is achieved through lifestyle changes. In the event of unsuccessful therapy, the ultima ratio is surgical gastric reduction. The volume of the stomach is reduced and body weight reductions of around 25 to 30 percent are the result. But the cost is high: in the United States, gastric surgery costs about $25,000 to $35,000. In Germany, such an operation costs between 8,000 and 15,000 euros.
The new potential drugs are all the more exciting. Novo Nordisk’s Wegovy is already approved in the United States for the treatment of obesity and easily costs more than 1,000 US dollars per year – mind you, with a possible weight reduction of over 15 percent. Eli Lilly’s new drug, with more than 20 percent weight reduction, is likely to be priced similarly, allowing many government payers to choose the simpler and cheaper drug treatment over stomach reduction surgery.
Only with enough clinical data
If only 10 percent of the world’s more than 750 million obese people were drugged at an annual cost of $1,000 per year for Wegovy or Mounjaro, the market would be over $70 billion: a market with enough room for two big pharmaceutical companies. However, the prerequisites are positive study results, proof of tolerability and, above all, the decision of the payers to also include the above-mentioned drugs in the reimbursement obligation for a given indication. The need for this is there. Numerous complications of obesity are known (and costly), such as prediabetes and diabetes mell. Type 2, high blood pressure, cardiovascular disease, obstructive sleep apnea, liver changes, etc. With good reason, the WHO has officially classified obesity as a disease and not just a handicap.
Covid-19 and obesity: Higher risk of hospitalization
Attention is also being paid to the link between Covid-19 and obesity, as the latter seems to favor a severe course of Covid-19. According to the German Obesity Society and studies from the University of Oxford, people with obesity have a twofold increased risk of being hospitalized if they contract Covid-19. Rapid booster vaccinations are also important for people who are severely overweight to protect against a severe course and help to prevent deaths. Being overweight is one of the most common risk factors for a severe course of Covid-19, along with cardiovascular disease and diabetes. This is particularly relevant in the current time of the corona summer wave and should become even more important with the possibly upcoming autumn wave.
The study data from BioNTech/Pfizer or Moderna on the modified vaccines in autumn will be all the more important, as they will probably make another booster vaccination seem sensible in order to offer better protection for the possible autumn wave. BioNTech/Pfizer and Moderna will remain technological leaders in 2023.
Conclusion
Studies predict an increase in obesity diseases to around one billion people worldwide. The number of diabetics (type 1 and 2) is expected to increase to 587 million people over the same period. Pharmaceutical companies with a focus on therapies for diabetes and obesity therefore remain interesting. The year 2023 will be particularly exciting for the companies Novo Nordisk and Eli Lilly. Novo Nordisk should have the in-house supply chain problems at Wegovy under control by then, and Eli Lilly could penetrate the market with rapid volume growth. Both short-term (fall wave) and long-term (mRNA technology in other indications) therapeutic opportunities will play a role for the mRNA technology companies. Because (not only) Covid-19 will unfortunately continue to accompany us in 2023.
Obesity – a widespread disease from an investor’s point of view
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