GLP-1 drugs like Ozempic and Mounjaro have transformed weight management around the world, with everyone from celebrities to the NHS touting their benefits for weight loss and type 2 diabetes.
Health Tech World speaks to MetaVia CEO Hyung Heon Kim about the history of GLP-1s and the challenge of establishing a new drug in a crowded market.
The GLP-1 market is already very well established, with major players Ely Lilly and Novo Nordisk leading the pack. Isn’t MetaVia too late to compete?
Those companies weren’t actually the first to get into this market.
In the early-to-mid 2010s, lots of companies were looking into GLP-1s, especially for type 2 diabetes, but the big names weren’t interested because of all the cheap generics.
But our strategic partner Dong-A was different.
A leader in Korea, the company has been in the metabolic disease space for more than 90 years. So it made sense for them to look at developing a dual agonist type-2 diabetes drug that could provide additional benefits to patients.
During the 2010s, Johnson & Johnson ran a phase-2 study combining GLP-1 and glycogen, but the candidate failed.
The problem was that GLP-1 lowers blood glucose levels while glucogen increases them. And when you don’t have the optimum balance between these two, there’s no glycemic control.
The Dong-A research centre in Korea realised that if you could provide more balance from the GLP-1, you could deliver better glycemic control, and the drug would be more tolerable.
Side effects have become a big concern for manufacturers and patients alike. Are you worried that regulations for newcomers will become stricter?
Potentially, yes. There is a risk that doctors will be hesitant to prescribe new drugs.
Take Triple G, for example. This is a GLP-1, GIP and glucagon drug developed by Ely Lilly.
Trials have shown that patients on the drug can lose 30 per cent of their body weight.
But in those trials, more than 20 per cent of patients dropped out because of side effects. And these were patients effectively being paid to lose weight!
So if you’re a doctor, you’re probably only going to prescribe it to patients who need to lose a lot of weight.
How are you different from other companies combining GLP-1 and glucagon?
Look at approved drugs semaglutide and tirzepatide.
It takes six months to titrate to the optimum dose. And if your insurance doesn’t cover obesity drugs, you’ll be fitting the bill.
Hyung Heon Kim
But what if there’s no need for titration and you could use maybe 15 per cent body weight over those first six months?
That’s what will make us different
What have trials shown so far?
A four week trial on a 32 milligram dose saw a mean weight loss of 4.3 per cent.
We’re now trialling a 48 milligram dose over eight weeks, with the results coming out by the end of the year.
It would be really impressive if people could lose 8 per cent of their weight in that time.
It will be interesting to see how well-tolerated the drug is without having to follow titration.
As you said, many insurance companies won’t cover weight loss drugs. How do you get around this?
In the US, Ozempic and Mounjaro are both covered for type 2 diabetes. And almost 70 per cent of obese people have prediabetes or type 2.
So actually, less than a third of people who need these drugs for obesity can’t get insurance for them.
There are differences in how pharma companies have approached this.
Novo Nordisk first launched Ozempic and then later WeGovy, both using the same ingredient, semaglutide.
The main difference between the two is the dose, with WeGovy containing higher levels of the active ingredient.
This means that patients who take Ozempic for type 2 diabetes will lose less weight than patients on Wegovy.
Compare that to Eli Lilly’s Mounjaro for type 2 diabetes and Zepbound for obesity which again contain the same drug, in this case tirzepatide.
In this case, patients treated for type 2 diabetes can receive insurance coverage for a drug that causes a better degree of weight loss.
As newcomers, we need to learn from these different marketing strategies.
The big takeaway is that a new drug has to treat type 2 diabetes otherwise it won’t be insured.
How do you hope to overcome the supply issues that have plagued the GLP-1 market?
Our strategic backer in Korea has manufacturing sites there, and we always get priority, so we’re in a better position than other companies.
And there’s been another interesting development at Ey Lilly, with their Lilly Direct programme.
They’re actually selling dry powder vials directly to patients, which was unheard of. That’s changed the whole dynamic.
What applications do you see for GLP-1s beyond obesity and type 2 diabetes?
MASH [metabolic dysfunction-associated steatohepatitis] is a big one.
Ely Lilly and Novo are targeting sleep apnoea. And there’s another company treating alcohol-related liver disease with the GLP-1/glucagon combination.
But still, type 2 diabetes is always going to be the most important [from an insurance perspective] as that’s the disease that most obesity patients have.
What’s next for MetaVia?
We’re really excited about our 48 milligram study. I’m hoping that the data will put us on the map and get people talking.
Then we’ll start a phase 2 next year and will definitely be adding a type 2 diabetes arm.
This is a really competitive market but there’s still room for innovation when you focus on what matters to patients.
