How Eli Lilly became the new king of the anti-obesity drug market

State of play: While Novo leads in sales for the moment, Eli Lilly's dual-agonist injectables have shown better efficacy in clinical trials and are said by doctors and patients to be more tolerable, market analysts say.

• The Indianapolis-based Lilly has also led in direct-to-consumer sales of GLP-1s and has a stacked pipeline of next-generation obesity treatments — including daily pills that could be more convenient and easier to manufacture than injectable versions.
• Pharma market intelligence firm Evaluate projects Lilly's sales of its flagship obesity drug Zepbound will reach $18 billion next year, surging past the expected $16.5 billion in sales for Wegovy, said Ben Folwell, Evaluate's business, development and licensing lead.

Lilly has two new injectable anti-obesity drugs in trials. One mimics three separate gut hormones including GLP-1 and glucagon — which early data suggests could be one of the most potent weight loss hormones.

• It also has orforglipron, an oral GLP-1 taken daily that the company plans to file for Food and Drug Administration approval by the end of this year with a goal to begin selling by the middle of 2026.
• Analysts say Lilly may have an important edge with oral weight-loss drugs since its pills don't require patients to fast — unlike Novo's, which require holding off eating or drinking for at least 30 minutes before and after taking.

"It's actually a pretty simple story ... the better drugs won," Michael Nedelcovych, director of equity research at TD Cowen, said of Lilly.

• "The reason why it took us by surprise wasn't the fact that Lilly overtook Novo. It was just how quickly it happened," he said.
• Lilly CEO David Ricks boasted during the company's second quarter earnings call in August that its drug Mounjaro also recently became the market leader in the U.S. in total prescriptions for Type 2 diabetes.
• "While the company is experiencing rapid revenue growth, we're also increasing our [research and development] investment, as early phase program data continues to impress us, and to support our future growth of the company," Ricks said.

Yes, but: Last week, Novo got an FDA nod for its oral GLP-1 drug Rybelsus to reduce the risk of cardiovascular events in those with Type 2 diabetes.

• Wegovy also became becomes the first GLP-1 drug approved to treat the metabolic condition MASH, formerly referred to as fatty-liver disease. The company also recently acquired Akero Therapeutics for up to $5.2 billion in a deal focused on metabolic diseases.
• Novo also is awaiting FDA approval of an oral version of Wegovy in early 2026 — the first such oral option for obesity and an opportunity for market expansion to patients who may feel uncomfortable with using an injectable drug, Dave Moore, executive vice president of Novo's U.S. operations, told Axios.
• "You should expect Novo to continue to be a leader in this space," Moore said. "This is our mission, and we will continue to innovate new medicines and bring those to market."

• The oral version of Wegovy will be entirely manufactured in North Carolina, which would engender goodwill with the Trump administration.

And yet, "investors still feel it's too little too late," said Andy Hsieh, a biotechnology research analyst at William Blair. "With this unrelenting assault against Novo by Lilly, the momentum is insurmountable in a way."

Friction point: The GLP-1 market may not be a two-horse contest for long. Other drug giants including Roche, AstraZeneca, Merck, Amgen and Pfizer are all are chasing their own piece of the obesity market, largely through acquisitions of biotechs.

• After seeing two of its experimental drugs fail over the last year, Pfizer jumped back into the obesity drug race last month with a $4.9 billion acquisition of Metsera and its portfolio of experimental medicines.
• In the short term, they aren't expected to break Lilly and Novo's stranglehold on the market or bring prices down, Nedelcovych said.
• But in the long term, these are major drug companies and could pose a bigger threat to these market leaders.

What we're watching: How big of an impact oral GLP-1s have on the market. It's an open question in the U.S., which has more patients with greater amounts of weight to lose, analysts said.

• While some have called the move to orals a potential game changer, physicians have predicted they'd only recommend the drugs to roughly 15% to 30% of their patients. Moore said that still is a potentially meaningful market expansion.
• Both Lilly and Novo also are pushing legal challenges against a compounding industry that's producing cheaper knock-off versions of their top obesity treatments, eating into their marketshare.
• And there's still the issue of whether the Trump administration will reverse a long-standing Medicare policy against paying for weight-loss treatments.

The bottom line: "Lilly definitely has the lead, so it's kind of their race to lose at this point," Nedelcovych said. "The question is: How does Novo regain traction?"