By Godson Umejiego, Correspondent USA

Eli Lilly and Novo Nordisk will continue to compete over the glucagon-like peptide 1 receptor agonist (GLP-1RA) market, with the strong possibility that the two pharmaceutical giants will completely own the space due to the current lack of other marketed competitors, including biosimilars. The two giants will likely push out the remaining competition, namely AstraZeneca’s exenatide franchise, says GlobalData, a leading data and analytics company.

At the 81st Scientific Sessions of the American Diabetes Association (ADA) annual meeting, data was presented on a variety of antidiabetics that fall under the GLP-1RA umbrella, including Eli Lilly’s tirzepatide, Novo Nordisk’s Ozempic (semaglutide, 2mg), and AstraZeneca’s Bydureon (exenatide ER). Tirzepatide is a once-weekly, dual glucose-dependent insulinotropic polypeptide (GIP) and GLP-1RA, while Ozempic and Bydureon are once-weekly, injectable GLP-1RAs.

Jesse Cuaron, PhD, PPM, Director at GlobalData, comments: “Key opinion leaders (KOLs) interviewed by GlobalData noted that an increasing number of GLP-1RAs have become available, and that there is a general trend of physicians both increasingly prescribing GLP-1RAs to type 2 diabetes (T2D) patients with comorbidities and introducing the drug class earlier in the management of T2D.”

The SURPASS-1 study was a 40-week, multi-center, randomized, double-blind, parallel, placebo-controlled, Phase III trial in which tirzepatide (5mg, 10mg, and 15mg) was shown to reduce hemoglobin A1c (HbA1c) by 2.07% and decrease weight by 11 per cent compared to placebo in T2D adult patients. Notably, the therapy was able to help patients achieve HbA1c levels that are within the normal range for non-diabetic individuals (below 5.7%). At the highest dose of 15mg, tirzepatide demonstrated additional benefit by reducing total cholesterol, triglycerides, and low-density lipoprotein (LDL) cholesterol, while increasing high-density lipoprotein (HDL) cholesterol.

Eli Lilly also revealed that tirzepatide was able to demonstrate superiority in T2D adult patients over Novo Nordisk’s Ozempic (semaglutide, 1mg) in SURPASS-2, which was a 40-week, multi-center, randomized, parallel, open-label trial. Specifically, tirzepatide demonstrated reductions in both HbA1c and weight in T2D patients when compared to Novo Nordisk’s GLP-1RA. Novo Nordisk has also released recent data showing that its Phase IIIb SUSTAIN FORTE trial of Ozempic (semaglutide, 2mg) conferred superior reductions in HbA1c compared to Ozempic (semaglutide 1mg). The study met its primary endpoint, with Ozempic (semaglutide 2mg) reducing HbA1c by 2.2 per cent, compared to Ozempic (semaglutide 1mg) reducing HbA1c by 1.9 per cent.

Cuaron continues: “Tirzepatide’s novel dual mechanism of action establishes it as a first-in class GLP-1/GIP, and a strong contender against competitors in the T2D market. The data presented at ADA 2021 confirmed this.”

Data was also presented for Bydureon, showing that children and adolescents who received the drug witnessed a 0.36 per cent reduction in HbA1c compared to an increase of 0.49 per cent seen in the placebo arm. This is significant given that this was the first completed trial utilizing a once-weekly GLP-1RA to be completed in this age group of T2D patients.

Cuaron concludes: “KOLs also noted that the market is becoming increasingly crowded, in a space that has already had one GLP-1RA, GlaxoSmithKline’s Tanzeum (albiglutide), taken off the market due to low sales stemming from the highly competitive market and issues surrounding the administration of the drug.”