Orforglipron

On December 16, Merck announced on its official website that it has officially stopped the development of the anti-TIGIT antibody Vibostolimab and the anti-LAG-3 antibody Favezelimab. This decision marks the end of Merck's years of effort in the field of immune checkpoint inhibitors. Two days later, on December 18, Merck announced its new strategic direction by reaching a collaboration agreement with domestic company Hansoh Pharmaceutical. According to the agreement, Merck will obtain global exclusive licensing rights for Hansoh’s oral small molecule GLP-1 receptor agonist HS-10535, while Hansoh will retain control of the drug in the Chinese market. The total amount of this collaboration is as high as $2 billion. This series of business adjustments reflects Merck's concerns about the impending patent cliff for its main product, Pembrolizumab (Keytruda). At the same time, these adjustments provide clues about future competitive focuses for innovative pharmaceutical companies. Vibostolimab, which Merck has discontinued, is an antibody drug targeting the TIGIT site. TIGIT is an inhibitory receptor expressed on T cells and NK cells, belonging to the immunoglobulin superfamily. Vibostolimab aims to block the TIGIT signaling pathway to enhance the body's immune response against tumor cells. Although TIGIT is regarded as a potential therapeutic target, Merck and several other pharmaceutical companies like Roche have conducted long-term development in this area but have not achieved success. Vibostolimab faced failures in multiple clinical trials, including the KeyVibe-002 trial in patients with metastatic non-small cell lung cancer (NSCLC) and studies in high-risk melanoma patients. Similarly, Merck's other drug Favezelimab is an antibody drug targeting the LAG-3 site, aiming to restore the effector function of T cells. Despite several clinical studies, including the Phase III KEYFORM-007 study in PD-L1 positive microsatellite stable (MSS) metastatic colorectal cancer (mCRC) patients, Favezelimab also failed to meet its primary endpoint, leading Merck to decide to terminate its clinical development program. After abandoning Vibostolimab and Favezelimab, Merck's next research focus shifts to the oral small molecule GLP-1 receptor agonist HS-10535. GLP-1 related products, as weight loss drugs, hold significant appeal for pharmaceutical companies. Novo Nordisk and Eli Lilly have already reaped substantial profits from their GLP-1 products. Merck began its layout in the GLP-1 project back in 2010, but has yet to successfully launch a product. This collaboration with Hansoh Pharmaceuticals may provide Merck with an opportunity to break through in this field. Currently, the oral Semaglutide tablet (Rybelsus) is the only marketed oral GLP-1 drug, utilizing SNAC technology to facilitate transcellular absorption through the gastric mucosa. Eli Lilly’s Orforglipron is leading the field of oral GLP-1 receptor agonists, while domestic companies such as Heng Rui Medicine's HRS-7535 and Wenshan Medicine's VCT220 are also actively developing. With the impending expiration of the Keytruda patent, Merck is under pressure to find its next blockbuster. Despite setbacks in the research of TIGIT, LAG-3, and GLP-1 targets, Merck's bet on oral GLP-1 small molecule drugs may provide it with a chance to overtake competitors.

On December 20, Novo Nordisk announced the primary results of its Phase 3 REDEFINE-1 clinical trial for the next-generation weight-loss drug CagriSema. The 68-week trial involved 3,417 participants with a baseline weight of 106.9 kg. The results showed that patients receiving subcutaneous injections of CagriSema achieved an average weight reduction of 22.7% (based on trial product estimates) or 20.4% (based on treatment policy estimates). CagriSema is a combination drug composed of semaglutide and a long-acting amylin analog, cagrilintide. Given Novo Nordisk's success with semaglutide in diabetes and weight loss, CagriSema was highly anticipated as the next-generation product. However, following the announcement of the REDEFINE-1 trial results, Novo Nordisk's stock plummeted by 28% in pre-market trading, closing at $85, with a market value loss exceeding $82.1 billion. Although CagriSema’s weight-loss efficacy over 68 weeks was comparable to the already marketed tirzepatide, the market's elevated expectations led to the sharp stock decline. From a data perspective, CagriSema’s weight-loss effect failed to meet the company's original target of a 25% reduction, putting it at a disadvantage compared to tirzepatide. Additionally, CagriSema lags behind tirzepatide in clinical and commercialization progress, with the latter expected to launch in 2025. This setback for Novo Nordisk may reshape the global weight-loss drug market. Although CagriSema’s efficacy is comparable to tirzepatide, its market value has significantly diminished due to unmet expectations. In the fiercely competitive weight-loss drug market, Novo Nordisk appears to have little room for error. On one hand, Eli Lilly’s tirzepatide, a dual-target drug, is not even its strongest asset in weight management—its triple-target GLP-1 drug, retatrutide, has shown superior weight-loss results in Phase 2 trials. On the other hand, Novo Nordisk leads in targeting amylin, with both CagriSema (a subcutaneous combination therapy) and Amycretin, an oral dual-target GLP-1 and amylin drug (currently in Phase 1 trials). Additionally, Novo Nordisk has invested heavily in CB1 receptor agonists, though these pipelines are still in early stages. CagriSema’s mechanism relies on semaglutide's ability to boost insulin secretion, while amylin, like insulin, is secreted by pancreatic β-cells. Together, they enhance weight loss by controlling postprandial blood sugar levels and increasing satiety. Amylin also offers better blood-brain barrier permeability and reduced negative impact on muscle. In Phase 2 clinical trials, CagriSema demonstrated remarkable efficacy, with treated patients achieving 15.6% weight loss at week 32, compared to 5.1% in the semaglutide group. However, the incidence of gastrointestinal adverse events with CagriSema was nearly twice that of monotherapy, which may have contributed to the less-than-expected results. Despite lower overall adverse event rates than monotherapy in Phase 2 trials, CagriSema's higher gastrointestinal side effects may impact patient tolerance. Novo Nordisk plans to conduct a low-dose flexibility study next year, but investors remain skeptical of its efficacy. Beyond the REDEFINE-1 trial, Novo Nordisk has multiple ongoing head-to-head clinical trials between CagriSema and Eli Lilly's tirzepatide. Future competition for CagriSema will center not only on weight-loss efficacy but also on other health metrics, such as preservation of lean muscle mass. In the race for oral weight-loss drugs, Novo Nordisk is banking on Amycretin, a dual-action GLP-1 and amylin receptor agonist with long-acting effects, aiming to become a best-in-class (BIC) oral weight-loss medication. Despite the crowded competition, Amycretin has shown potential for rapid and substantial short-term weight loss. Globally, the competition for oral weight-loss drugs is intense. While Pfizer and Eli Lilly are ahead, Pfizer's molecules have faced safety challenges, and Eli Lilly's Orforglipron showed inferior weight-loss efficacy compared to injectable formulations in recent Phase 2 data presented at the 2023 ADA conference. Leading MNCs like Roche, AstraZeneca, and Merck are entering the field, while Chinese biotech firms also benefit from substantial BD investments. Although no small-molecule oral GLP-1 drugs are currently on the market, Eli Lilly's Orforglipron, the closest to commercialization, has shown weak weight-loss results, while Novo Nordisk’s Amycretin and Roche’s CT-996, still in early clinical phases, demonstrate promising efficacy but lack large-scale safety data. Chinese biotech firms may find opportunities in developing small-molecule GLP-1 drugs. As more MNCs join the race and additional GLP-1 pipeline data emerges, the market will rapidly elevate the standards for future GLP-1 data. Novo Nordisk's CagriSema’s underwhelming Phase 3 results may tip the balance of injectable GLP-1 drug competition toward Eli Lilly. However, the most intense and brutal competition for small-molecule oral GLP-1 drugs has only just begun.