Overall, 2017 was not exactly a stellar year for the obesity drug market, with more downs than ups, and although the unmet need for novel drug treatment remained high, issues that have plagued weight loss drug development in the past did so again. Nonetheless, a considerable market opportunity still exists if developers can get it right.

 

Epidemic proportions

The evidence of the physical and financial threats from obesity continue to mount throughout 2017. One study anticipated that 50% of children will be obese by the age of 35,1 and another showed increasing rates of obesity-associated cancers.2 Even a study with the mildly positive news that childhood obesity rates appear to have plateaued in high-income countries, also reported that rates are accelerating in some Asian countries.3 Moreover, access and reimbursement continued to be suboptimal across major markets. Importantly, efforts to deal with the obesity epidemic are slowly gearing up. The Treat and Reduce Obesity Act of 2017 was introduced into the U.S. Congress with the aim of providing better access to treatment, and the numbers of physicians specializing in obesity medicine continued to rise in the United States (Obesity Society press release, May 25, 2017).

 

Challenges persist

However, challenges persist with managing obesity. Many countries still do not consider obesity as a disease. The result of the ACTION (Awareness, Care, and Treatment in Obesity maNagement) study found that diagnosis and treatment rates are low, obese patients often wait until after they have had a life-changing medical event to focus on weight loss, and even if there is a medical intervention, follow-up is poor.4 Prescription weight loss drugs continue to be underutilized with < 2% of eligible patients receiving such treatments.5 Part of this could be due to poor safety profiles for many of the available agents; loss of consciousness with Orexigen Therapeutics’ Contrave/Mysimba (naltrexone/bupropion) has been reported in 2017 (https://www.fda.gov/Drugs/GuidanceComplianceRegulatoryInformation/Surveillance/AdverseDrugEffects/ucm549834.htm; accessed February 19, 2018). Moreover, there are now numerous procedures available to assist with weight loss, ranging from intragastric balloons and intestinal sheaths through to major surgery. Despite the benefits, such invasive interventions are expensive and not risk-free; a more efficacious drug treatment could go a long way to meeting the important need for safe, effective, and affordable weight management.

 

New hope

Uptake of Novo Nordisk’s glucagon-like peptide-1 (GLP-1) receptor agonist, Saxenda (liraglutide 3 mg), has been steady, but its high price is not expected to lead to widespread use. Having said that, even minor market penetration into a disease as prevalent as obesity is likely to enable Saxenda to reach blockbuster sales. Saxenda was launched in several new markets in 2017. In addition, distribution agreements for Mysimba were announced for Germany and France, amongst other nations. Of greater interest is Novo’s next-generation GLP-1 receptor agonist semaglutide. Results from a Phase II trial in obese patients demonstrated a > 10% placebo-adjusted weight loss after 52 weeks (Novo Nordisk press release, June 23, 2017), a result which, if replicated in Phase III trials would make semaglutide one of the most effective agents on the market. Moreover, like Saxenda, physicians are likely to be familiar with the drug as it is already approved for type 2 diabetes (Novo Nordisk’s Ozempic). Just how widely it will be used will likely come down to pricing.

 

Next steps

As we have yet to find the silver bullet (or more likely bullets) for obesity, research continues in the hope that one or several new targets may yield success. During 2017, scientists have identified new genes (ankyrin-B, PTCD1, TMEM18), new proteins (growth differentiation factor-15), and new ways of targeting fat (nanoparticles administered by transdermal patches), all of which may lead to new treatments. Sooner rather than later, hopefully.

 

For more information on DRG’s assessment of the Obesity market, please click here.

 

References

 

  1. Ward ZJ, et al. Simulation of growth trajectories of childhood obesity into adulthood. N Engl J Med. 2017;377:2145-2153.
  2. Steele CB, et al. Vital Signs: Trends in Incidence of Cancers Associated with Overweight and Obesity - United States, 2005-2014. MMWR Morb Mortal Wkly Rep. 2017 Oct 3;66(39):1052-1058.
  3. NCD Risk Factor Collaboration (NCD-RisC). Worldwide trends in body-mass index, underweight, overweight, and obesity from 1975 to 2016: a pooled analysis of 2416 population-based measurement studies in 128·9 million children, adolescents, and adults. Lancet. 2017 Dec 16;390(10113):2627-2642.
  4. Kaplan LM, et al. Perceptions of Barriers to Effective Obesity Care: Results from the National ACTION Study. Obesity (Silver Spring). 2018 Jan;26(1):61-69.
  5. Saxon D, et al. Anti-Obesity Medication Use in 2.2 Million Adults Across 8 Large Healthcare Organizations: 2009-2015. 35th Annual Scientific Meeting of The Obesity Society 2017, Washington DC. Abstract T-OR-2070.

 

 

 

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