Europe’s most valued company today is a pharmaceutical company – Denmark’s Novo Nordisk, valued at more than half a trillion dollars, having tripled in the last three years. All thanks to its wonder drug for weight loss, Wegovy, sales of which touched $4.5bn in 2023 up 5x over 2022. It’s closest competitor, Zepbound sold $2.9bn making its parent, American pharma major Elil Lilly’s market cap double to $750bn heading to be the first trillion-dollar pharma company. This article gives us a primer on the science behind the drug and the excitement about its future.

The drug originally designed to cure diabetes found a bigger use case for treating obesity, an epidemic in itself.

“Since the late 1980s scientists believed that a gut hormone called glucagon-like peptide-1 (GLP-1), which is secreted by the intestines after a meal, could help treat diabetes. GLP -1 increases the production of insulin (a hormone that lowers blood-sugar levels) and reduces the production of glucagon (which increases blood-sugar levels). But GLP -1 is broken down by enzymes in the body very quickly, so it sticks around for only a few minutes. If it were to be used as a drug, therefore, patients would have faced the unwelcome prospect of needing GLP-1 injections every hour.

In 1990 John Eng, a researcher at the Veterans Affairs Medical Centre in The Bronx, discovered that exendin-4, a hormone found in the venom of the Gila monster, was similar to human GLP-1. Crucially, the exendin-4 released after one of the monster’s rare meals is more resistant to enzymatic breakdown than GLP-1, staying in its body for hours. It took more than a decade before exenatide, a synthetic version of the lizard hormone, created by Eli Lilly, an American pharma giant, and Amylin Pharmaceuticals, a biotech firm, was approved to treat diabetes in America. This breakthrough spurred other firms to develop more effective and longer-lasting GLP-1 medications as a treatment option for diabetes, beyond injections of insulin.

Scientists had also been aware that GLP-1 had another side-effect: it slowed the rate of “gastric emptying”, which allows food to stay in the stomach for longer and suppresses appetite. But the potential weight-loss benefits were not seriously pursued at first. It was only in 2021 that Novo Nordisk, a Danish firm, showed data from a clinical trial where overweight or obese patients were put on a weekly dose of its GLP-1-based diabetic drug, semaglutide, which was then being marketed under the name Ozempic, for 68 weeks. The results were dramatic—participants had lost 15% of their body weight, on average.”

The drugs are turning out to be wonder drugs indeed as recent studies show that their use cases go beyond treating obesity and diabetes to address heart ailments, kidney problems, fatty liver and potentially even Alzheimer’s. The article goes on to elaborate on the drug’s other therapeutic areas.

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