CT-388

None With the obesity market projected to exceed $130 billion by 2034, many major pharmaceutical players are rapidly advancing pipelines to capitalize on what is arguably the most dynamic space in the industry. To identify the companies positioned to outperform, FENIX has created the Obesity Power Rankings of the Top 10 players. For context, >20 companies were assessed across more than 15 weighted criteria, including pipeline depth, clinical differentiation, and commercial infrastructure, to derive a composite score out of five. If you’re interested in a deeper look at the full assessment framework, please contact the FENIX team. Below, FENIX outlines the rationale for all rankings and highlights key headwinds and tailwinds that shape each company’s position:   Lilly (4.9/5): Lilly remains the undisputed market leader in obesity, as evidenced by its tirzepatide franchise becoming the world’s top-selling drug in 2025, surpassing Merck’s Keytruda to generate >$36 billion in annual revenue. While Lilly possesses a robust late-stage pipeline which is anticipated to help defend its leadership position, near-term momentum is expected to center on the orforglipron launch in Q2 2026. Considering Novo’s Wegovy Pill appears to hold a marginal edge in terms of efficacy, Lilly’s commercial team may need, for once, to come from behind. Novo Nordisk (4.8/5): Having effectively pioneered the modern obesity market with semaglutide, Novo entered 2026 confronting a convergence of executional challenges and a visible decline in innovation, factors that culminated in the company issuing its first negative annual sales outlook since semaglutide’s ascent. Novo now relies on strong launches of injectable 7.2mg Wegovy, Wegovy Pill, and CagriSema to stabilize its US market share and rebuild investor confidence. While these launches may alleviate near-term pressures, it remains uncertain whether Novo has truly identified a long-term successor to semaglutide. Pfizer (4.1/5): Following its $10 billion Metsera acquisition and licensing agreement with YaoPharma in 2025, Pfizer has significantly vaulted up the competitive rankings. While the company previously faced multiple setbacks in obesity (e.g., danuglipron and lotiglipron discontinuations), Pfizer finally appears to have assembled a differentiated pipeline that can fully leverage its established commercial and manufacturing infrastructure. Roche (4.0/5): Despite its historically limited presence in the cardiometabolic space, Roche has publicly emphasized its ambition to become a Top 3 player in the obesity market. Following the recent encouraging topline CT‑388 Phase 2 results, attention now turns to the upcoming Phase 2 petrelintide readout in H1 2026, a pivotal catalyst that will likely shape the trajectory of its partnership with Zealand and, ultimately, Roche’s broader obesity aspirations.  AstraZeneca (3.6/5): A compelling case can be made that AZ has the pipeline depth to emerge as a dark horse contender for the third-place position in the power rankings. The company quietly advanced a broad mid-stage pipeline throughout 2025; and with multiple Phase 2 readouts expected in 2026, it's licensing agreement with CSPC Pharmaceuticals, which added a monthly dual agonist to its arsenal, further strengthens it as a serious contender.  Amgen (3.3/5): Amgen is effectively placing a concentrated bet that MariTide’s extended dosing will be its key differentiator in the future obesity market. While quarterly maintenance dosing is differentiated, it remains to be seen whether the company can overcome the Phase 2 tolerability issues that unsettled investors at ADA 2025. Boehringer Ingelheim (3.0/5): With data from the Phase 3 survodutide program anticipated to begin reading out in H1 2026, BI is set to become the first challenger to the current Lilly+Novo duopoly. Even with positive Phase 3 survodutide data, BI likely needs to expand its pipeline beyond its Phase 2 triple agonist to become a long-term competitive player in the space. Regeneron (2.9/5): While it was previously believed Regeneron was taking a tangential approach in the obesity market, looking to develop lean mass-sparing assets, its in-licensing deal for olatorepatide in June 2025 revealed the company’s broader obesity ambitions. However, similar to both BI and Amgen, it is believed Regeneron also needs to further diversify its portfolio to be considered a future leader in obesity. Zealand Pharma (2.4/5): Zealand, guided by CEO Adam Steenburg’s ambition to end what he describes as the “Weight Loss Olympics,” is making a strategic bet that amylin will become the next foundational anti-obesity class. Following Zealand’s partnership with Roche for petrelintide, the upcoming Phase 2 ZUPREME-1 readout will offer the first meaningful look into whether petrelintide lives up to the TPP promise. Kailera Therapeutics (2.2/5): Having licensed China-based Hengrui’s GLP-1/GIP dual agonist (ribupatide), which has already demonstrated strong late-stage weight loss efficacy in a Chinese population, Kailera initiated its own Phase 3 program evaluating higher doses (>6 mg) over longer treatment durations. It will be interesting to see if Kailera follows the traditional path of partnering with Big Pharma or if it goes alone with a new US commercial model (i.e., solely direct-to-patient).