Some leading U.S. obesity specialists say they expect Eli Lilly’s powerful weight-loss drug Zepbound will produce the same or similar heart benefits as Novo Nordisk’s popular Wegovy as they belong to the same class of medicines.
The views of the five doctors, all senior physicians practicing obesity medicine at top universities and hospitals, indicate that Novo's drug is not likely to have a significant edge based on its heart benefits, even though it will be years before Lilly produces similar cardiovascular data. Both medicines are GLP-1 agonists, a class originally designed to treat type 2 diabetes.
In Novo's pivotal Wegovy trial involving 17,604 overweight and obese people without diabetes, the drug reduced incidence of heart attack, stroke or heart-related death by an impressive 20%.
The Danish drugmaker said study participants’ heart health improved almost immediately, indicating the drug’s impact was not just from weight loss.
"I would anticipate that the cardioprotection with Wegovy would extend to Zepbound," said Dr. Edmond Wickham, an endocrinologist and associate professor at Virginia Commonwealth University.
The U.S. Food and Drug Administration on Nov. 8 approved Zepbound for weight loss. The product, which has the same active ingredient - tirzepatide - as its previously approved diabetes drug Mounjaro, is expected to start shipping it before the end of the year.
Wall Street analysts expect Lilly to reap in about $2 billion in sales from Zepbound in 2024. Barclays analyst Emily Field forecast $7.3 billion in 20224 sales for Wegovy.
Six doctors Reuters spoke with said they are more likely to prescribe Zepbound when it becomes available over Wegovy.
But revenue and which drug doctors prescribe in the short term may come down to available supplies, which are expected to be outpaced by skyrocketing demand for both Wegovy and Zepbound.
Analysts have said the weight-loss drug market could be worth $100 billion by the end of the decade.
The specialist doctors said they would prefer to prescribe Zepbound because it helped patients lose an average of 20% of their weight in its late-stage trial compared to 15% for Wegovy.
They said they would readily prescribe Wegovy (semaglutide) if their patients' insurance did not cover Lilly’s drug, or if future trial results do not produce similar heart benefits.
HEAD-TO-HEAD TRIALS
Lilly is enrolling for a cardiovascular outcomes trial to examine tirzepatide's impact on heart health in patients without type 2 diabetes with data expected in 2027, and completed enrollment for a similar trial in patients with type 2 diabetes, with data expected in 2024.
"We anticipate that both studies will help us learn about the impact of tirzepatide on cardiovascular-related and other outcomes relevant to these patient populations," Lilly said in an emailed statement.
The U.S. drugmaker is also running a head-to-head trial pitting Zepbound against Wegovy in overweight or obese patients with other weight-related health issues. That data is expected in 2025.
Lilly declined to comment on doctors' views that Zepbound might have the same or similar cardiovascular benefits as Wegovy.
Tirzepatide was also shown to be better at lowering blood sugar in adults with type 2 diabetes compared to semaglutide, the active ingredient in Wegovy, in a head-to-head study from 2021, one doctor noted.
“All things being equal, then you potentially give Zepbound because there is a greater degree of weight loss and a greater reduction in the blood sugars,” said Dr. Rohit Kedia, an endocrinologist at the large West coast-based healthcare system Providence.
Extended periods of high blood sugar can damage blood vessels and the nerves that control a person’s heart.
A study published on medRxiv in advance of peer review this week found overweight or obese adults lost more weight and shed pounds faster using Lilly's Mounjaro than those taking semaglutide, which is also the active ingredient in Ozempic.
Novo said it could not speculate on competitors and that its trial specifically investigated the effect of semaglutide and not other GLP-1s.
Dr. Chad Weldy, a cardiologist at Stanford University, said semaglutide showed the strongest evidence of preventing cardiovascular events like heart attack and stroke. He said he expected tirzepatide to show a similar benefit. For now, he prefers Wegovy, he said.
“If I prescribed semaglutide but insurers pushed back and wanted me to start tirzepatide, I would not have any problems with that,” he added.
Weldy pointed to a similar scenario with a different class of diabetes drugs, the SGLT-2 inhibitors.
AstraZeneca’s Farxiga was first shown to lower the risk of heart failure, but eventually Boehringer Ingelheim and Lilly’s Jardiance demonstrated a nearly identical benefit.
Jardiance sales rose nearly $2 billion the year after the heart benefits were added to its label.
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