Drug Giants Clash Over Weight Loss and Heart Health Drugs

A fierce competition between pharmaceutical giants Novo Nordisk and Eli Lilly unfolded at the European Association for the Study of Diabetes (EASD) conference in Milan, Italy, as both companies presented data on their respective weight-loss and diabetes medications. Eli Lilly claimed its drug, Mounjaro, achieved greater weight loss than Novo Nordisk's Wegovy, and that its new oral medication, Orforglipron, outperformed Novo Nordisk's oral semaglutide. Novo Nordisk countered by presenting data suggesting Ozempic better protects the hearts of diabetes patients.

In head-to-head trials for weight loss, Mounjaro demonstrated superior results. In the SURMOUNT-5 trial, adults with obesity or overweight lost an average of 20.2% of their body weight on Mounjaro compared to 13.7% on Wegovy after 72 weeks. Eli Lilly also presented an indirect comparison suggesting Mounjaro is superior to Wegovy HD, a higher dose of Wegovy, though the significance of this finding was debated due to the indirect nature of the comparison and similar discontinuation rates due to side effects.

Regarding heart health, Novo Nordisk presented an analysis of US insurance data suggesting Ozempic (semaglutide) at a higher dose of 2mg was associated with a 6% lower risk of major adverse cardiovascular events compared to remaining on a 1mg dose. However, the analysis was observational, and the company acknowledged that causal relationships could not be definitively established. An academic study published in Nature Medicine found both Mounjaro and Ozempic reduced the risk of heart attack, stroke, and death in type 2 diabetes patients without significant differences. Eli Lilly's own trial, SURPASS-CVOT, showed Mounjaro reduced the risk of major adverse cardiovascular events by 8% compared to the older GLP-1 drug, Trulicity, but did not prove superiority over Ozempic.

Eli Lilly also introduced data for its oral weight-loss drug, Orforglipron, suggesting it achieved greater weight and A1C reduction than oral semaglutide at a 25mg dose in an indirect comparison. However, this dose of oral semaglutide is not approved for diabetes in the US. A direct comparison in the ACHIEVE-3 trial showed Orforglipron at 17.2mg led to greater A1C and weight reduction than oral semaglutide at 14mg.

In Israel, despite obesity being recognized as a disease, weight-loss injections are not yet included in the public health basket for adults, though Wegovy was approved for adolescents last year. The cost of available oral weight-loss medications also remains a barrier for many patients.