Growth of the market
So far most of these drugs have been prescribed in the US. But even this market is still largely untapped.
An estimated 105 million US adults currently meet the criteria to be categorised as obese or overweight. 18
Currently only an estimated
take GLP-1s for weight loss. 19
The potential of these drugs is vast because cutting obesity rates in populations will mean huge medical cost savings elsewhere in health systems.
The next generation
22.5%
Present
Future
Beyond
GIP
Although they’ve recently exploded in popularity, GLP-1RAs have been available for over a decade. Drug companies are already well advanced in producing the next generation of anti-obesity drugs. Here’s a snapshot of what’s in the pipeline.
Eli Lilly’s Mounjaro targets GLP-1 as well as a second obesity-related hormone called GIP.
This drug is already on the market and has achieved higher weight loss than Semaglutide. A recent trial showed up to 22.5% weight loss.
Amylin Analogues
(Novo Nordisk, Zealand Pharma, Eli Lilly)
Amylin is another naturally occurring hormone that makes users feel sated, but it works on a different part of the brain to GLPs.
This means it can be used in synergy with GLP-1s as a combination therapy.
CagriSema, made by Novo Nordisk, is likely to be the main successor to Semaglutide.
In a trial that will read out this year, Novo expect to see around 25% total weight loss for this drug.
Anti-myostatins
These drugs can drive weight loss through a different mechanism and also preserve lean muscle mass, which is a problem with existing weight loss therapies. The main treatment here is Eli Lilly’s Bimagrumab.
In a recent Phase 2 trial this saw a reduction of fat mass of 20.5% and increased lean mass of 3.6%. 22
Oral treatments
i.e. drugs in pill format, could solve the issues of injector pen shortages.
The leader here is Novo Nordisk’s Amycretin.
The company expect it to be on par with CagriSema in efficacy.
Small Molecule GLP-1
(Eli Lilly, Pfizer)
To solve the production/supply problem, firms are racing to create a small molecule drug (the traditional format for drug production) which mimics the role of a GLP-1.
The main candidate here is Eli Lilly’s Orforglipron. This achieved up to 14.7% weight loss in Phase 2 trials.
A possible competitor is Amgen’s MariTide. This is a once-a-month injection.
Not only that, but these drugs have shown efficacy treating a number of other diseases.
Positive effects
GLP-1RAs have been hugely popular with doctors and patients, leading to worldwide supply shortages.
Heart
A recent study found that Semaglutide, the most widely-prescribed GLP-1RA, can protect against heart problems, reducing risk of major cardiovascular events by 20%. 13
Kidney
Clinical trials show Semaglutide can help slow progression of kidney disease. 14
Diabetes
There is early evidence it may help with dementia among patients with type 2 diabetes. 15
Cancer
GLP-1Ras have been associated with reduced risk of colo-rectal cancer. 16
Sleep
They have been shown to have positive effects on sleep apnea. 17
Estimates of prevalence of obesity in adults
Obesity BMI ≥ 30 kg/m2. All adults.
World Obesity Federation, worldobesity.org
Source: NCD RisC: ncdrisc.org/data-downloads-adiposity.html
China’s GLP-1RA market could grow at an estimated
2023
2033
annually from 2023 to 2033 20
23%
Global markets also offer potential for future growth.
The two main producers are Novo Nordisk (Ozempic, Wegovy) and Eli Lilly (Mounjaro).
Both are struggling to keep up with demand. The biggest issue is making the ‘autoinjectors’- devices similar to the Novopen insulin injector- that deliver the drugs at adjustable doses.
Drug producers are currently building some of the largest-ever drug manufacturing facilities in the world to meet demand. But supply is not expected to catch up with demand until later in the decade.
Perhaps the biggest problem at the moment is supply constraints.
by around 2030 21
US$100bn
Barclays predicts a
global market for obesity drugs
US$99bn
US$98bn
US$97bn
US$96bn
US$95bn
US$94bn
US$93bn
US$92bn
US$91bn
US$90bn
US$89bn
US$88bn
US$87bn
US$86bn
US$85bn
All of this is set to place a massive strain on already-stretched healthcare systems.
Obesity drugs:
a lifeline for global healthcare systems
and the threat of infectious diseases is constantly evolving. 3
Chronic diseases are on the rise
life expectancy is increasing2
And at the same time,
10.4bn
by mid-2080s
in 2050
9.7bn
The global population is expanding1
20.5%
25%
14.7%
Disease
Obesity is increasingly recognised as a disease – one that is linked to a number of other serious health issues.
of all new diabetes cases will be due to overweight, 18% of all cases of cardiovascular disease, 11% of dementia and 8% of cancers. 5
More than 1billion people are now living with obesity. 6
and has quadrupled among children and adolescents. 7
It is growing fast: worldwide, obesity among adults has more than doubled since 1990
60%
Nearly
Costs
The cost to healthcare systems is vast.
The estimated annual medical cost of obesity in the US alone was around
in 2019. 10
US$173bn
OECD8 countries currently spend around 8% of their healthcare budget treating overweight-related conditions. 9
Obesity
One of the greatest challenges faced by public health systems around the world is obesity.
Traditional remedies based around diet and exercise have low success rates. 4
Key
<5%
5-10%
10-20%
20-30%
≥30%
1- https://www.hermes-investment.com/uploads/2024/04/9d035d814164c6c6874974b1eb1a758a/fhl-sustainable-global-equities-2023-march-2024.pdf
2- https://www.hermes-investment.com/uploads/2024/04/9d035d814164c6c6874974b1eb1a758a/fhl-sustainable-global-equities-2023-march-2024.pdf
3- https://www.oecd-ilibrary.org/sites/6cc2aacc-en/index.html?itemId=/content/component/6cc2aacc-en
4- https://www.nature.com/articles/ijo2012114
5- https://www.oecd-ilibrary.org/sites/6cc2aacc-en/index.html?itemId=/content/component/6cc2aacc-en
6- https://www.imperial.ac.uk/news/251798/more-than-billion-people-living-with/#:~:text=In%20total%2C%20an%20estimated159%20million,the%20same%20group%20in%202017.
7- https://www.who.int/news/item/01-03-2024-one-in-eight-people-are-now-living-with-obesity
8- Organization for Economic Cooperation and Development (OECD) is an international governmental organization with 38 member countries.
9- https://www.oecd-ilibrary.org/sites/6cc2aacc-en/index.html?itemId=/content/component/6cc2aacc-en#:~:text=Overweight%20is%20associated%20with%20a,treating%20overweight%20and%20related%20conditions.
10- https://www.cdc.gov/obesity/data/adult.html#:~:text=Obesity%20is%20a%20common%2C%20serious%2C%20and%20costly%20disease&text=These%20are%20among%20the%20leading,%24173%20billion%20in%202019%20dollars.
11- https://www.surrey.ac.uk/news/comment-weight-loss-drug-semaglutide#:~:text=%E2%80%9CIt%20works%20by%20mimicking%20the,and%20stopping%20us%20from%20overeating.
12- https://www.nejm.org/doi/full/10.1056/NEJMoa2032183
13- https://www.bmj.com/content/383/bmj.p2668
14- https://www.kidneyfund.org/article/study-results-show-promising-effects-semaglutide-people-diabetic-kidney-disease#:~:text=The%20results%20from%20a%20recent,living%20with%20diabetic%20kidney%20disease.
15- https://alz-journals.onlinelibrary.wiley.com/doi/10.1002/trc2.12268
16- https://jamanetwork.com/journals/jamaoncology/fullarticle/2812769
17- https://pubmed.ncbi.nlm.nih.gov/38251405/#:~:text=All%20studies%20evaluated%20the%20outcomes,%2Dhypopnoea%20index%20(AHI).
18- https://www.goldmansachs.com/intelligence/pages/gs-research/weighing-the-glp1-market/report.pdf
19- https://www.goldmansachs.com/intelligence/pages/gs-research/weighing-the-glp1-market/report.pdf
20- https://www.nomuraconnects.com/focused-thinking-posts/chinese-pharma-to-ride-on-the-global-glp-1-drugs-bonanza/
21- https://www.cnbc.com/2023/09/09/big-pharma-blockbuster-obesity-drug-battle-is-headed-for-100-billion.html#:~:text=Barclays%20predicts%20a%20%24100%20billion,treatments%20for%20dementia%20and%20addiction.
22- https://www.nature.com/articles/s41366-024-01473-y
The GLP-1RA Revolution
Today, a revolution is taking place in the ways obesity can be treated. This stemmed from research into drugs to treat type II diabetes.
1
2
3
1
Drugs called GLP-1RAs mimic the actions of a hormone known as glucagon-like peptide 1 (GLP-1).
2
GLP-1 is released from the gut after a meal. It regulates insulin in the body, and also gives feedback to the brain, making the user feel full. 11
3
This has seen GLP-1RAs recognised as an aid to weight loss, and approved by the FDA.
The effects are clinically proven. In one study, based on a once-weekly dose plus lifestyle intervention, patients lost on average
body weight. 12
-14.9%
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8.0bn
in 2022
71.7
in 2022
by 2050
77.3
+5.6 years
Life sciences is one of the Sustainable Global Equity Fund’s key investment themes.
Read more about our other investment themes and how our investment process is designed to capture the best opportunities across global equity markets.
Not all themes are worth following...
Find out more here
The key innovations are taking place at a molecular level – via molecules that are
100,000 times smaller than the width of a hair.
Innovative new treatments
have the potential to transform obesity treatment and relieve a major cause of stress on healthcare systems.
Find out more here
2 million