In the obesity drug universe, the rise of GLP-1 medications was the Big Bang. Their sudden popularity over the past few years kicked off an ever-expanding race to market for more weight loss solutions, with pharma companies clamoring for a competitive edge to compete with the runaway leaders, Eli Lilly and Novo Nordisk.
The obesity R&D strategies have quickly become varied. Some companies are developing oral GLP-1s to offer a more convenient option over injectables, while others are leveraging entirely new molecules. And Big Pharmas are making bigger moves now too.
Last week, Roche announced a deal with Zealand Pharma, a Danish biotech with four obesity peptides in development including a differentiated glucagon/GLP-1 receptor dual agonist targeting obesity and MASH in partnership with Boehringer Ingelheim.
Under the deal, Roche is plunking down $1.65 billion, including $1.4 billion upfront and $250 million in anniversary payments, to license petrelintide, an amylin analog weekly shot. Zealand Pharma began enrolling participants in its phase 2b study of petrelintide late last year with the hope that the drug will trigger weight loss comparable to or better than GLP-1s without the same gastrointestinal side effects. The deal could be worth up to $5.3 billion with development and sales-based milestones, making it the largest obesity deal to date, the companies said.
“It's a very strong testament to [the belief that] petrelintide has best-in-class potential,” said Zealand’s CEO Adam Steensburg. “If you want to be a leader in this space, you don't go for second best.”
Readouts for a number of closely-watched obesity drug trials are expected throughout this year, teeing up potential competition between several large pharmas. And Zealand isn’t Roche’s only big play. The company picked up three obesity candidates when it acquired Carmot Therapeutics for $2.7 billion in 2023, which are in early- and mid-stage testing.
The deal with Zealand will also spur development for a new candidate that combines petrelintide with Roche’s CT-338, a dual GLP-1/GIP receptor agonist.
"It was very clear that Roche was the party who had thought the most about how to lead in this space, and also the party which we believe could best help us realize the full potential of petrelintide."
Adam Steensburg
CEO, Zealand Pharma
Here, Steensburg digs deeper into the partnership with Roche and why the obesity market is ripening for a GLP-1 alternative.
This interview has been edited for brevity and style.
PHARMAVOICE: How would you characterize the obesity drug landscape, and where do you see smaller companies fitting into it?
ADAM STEENSBURG: We are in the very early phase of addressing what we consider the biggest healthcare crisis of our time, namely the obesity pandemic. I would say we're not even taking the baby steps yet to address the global health issues associated with obesity, and that leaves significant room to come in with new innovations, set new standards of care and disrupt the market in the future. However, it has to be with differentiated molecules. I think there's very little room for things that are too similar to what we already have on the market.
If you look at many of the other players out there, I think they have me-too products. Yes, you might have a good product, but it may be too late. And who's going to invest in all the manufacturing capacity and the commercial rollout if you don't do something which is undifferentiated?
How did the partnership with Roche come about, and what are some of the key drivers of the deal?
Last year, we started a partnering process where we discussed with a large number of pharma companies the opportunity to come in and lead in a new category, an alternative to the GLP-1s … which at least so far, has shown significantly less side effects such as nausea and vomiting. [Our] amylin analog doesn't really affect people's appetite. It's more [about] making people feel full faster. So we think it can be a more pleasant experience to lose weight.
We reached out to companies to share our vision for why it's attractive to go for an alternative to the GLP-1 … and we saw very significant interest. It was very clear that Roche was the party who had thought the most about how to lead in this space, and also the party which we believe could best help us realize the full potential of petrelintide.
They have established quite a portfolio already, and they convinced us that they want to lead here and they know what it takes, including investments in manufacturing.
Lastly, it had to be a company where we saw a strong cultural fit, because we were only going to engage in a partnership if we could achieve a true co-development, co-commercialization partnership with profit share. And that means that we have to work together for a long period to deliver this product to the market.
Is that the marketing message of petrelintide — it's a more pleasant way to lose weight?
It is a clinical observation. Both GLP-1s and amylin [are] endogenous peptides, and amylin is released from the pancreas and stimulates leptin sensitivity. Many obese individuals actually have resistance towards leptin, and leptin is the satiety hormone that signals to the brain to stop eating. Amylin is a more natural satiety. It helps obese individuals who are resistant to leptin get that leptin sensitivity back, so they will stop eating earlier. That is also the observation that people have described when they have tried amylin analogs, that they don't lose that prospective food seeking.
Why partner with Big Pharma (again) at this stage?
When you consider the magnitude of the obesity pandemic, and thus the scope of this program, including how many patients we ultimately would have to reach in order to address the problem, we have known that we need a partner at one point to not only help us conduct the phase 3 programs and have the global commercial reach, but also to make all the manufacturing investments that are needed in order to have enough capacity.
What's the ‘why’ behind creating a new combination pipeline product with CT-388? If the amylin analog has such great results on its own, why test a combo?
With petrelintide, it's a product that can deliver a median of 15% to 20% weight loss. But there is a group of patients who need higher weight loss than most morbidly obese patients — those who, for instance, are candidates for bariatric surgery today. And there we see the combination as a fantastic opportunity. There are also patients with obesity who live with diabetes, that's around 20% of the obese population. There, a combination could also be a fantastic opportunity, because a GLP-1 is more active on glucose control.
