Is the obesity drug market still a duopoly?

Competition in the obesity drug market is set to intensify, with 23 new anti-obesity treatments expected to receive approval across major markets by 2031. This influx of therapies could challenge Danish drugmaker Novo Nordisk and American pharma giant Eli Lilly, which have long dominated the space with their GLP-1 receptor agonists—drugs that regulate appetite and blood sugar levels. Novo Nordisk’s Wegovy (semaglutide) and Eli Lilly’s Zepbound (tirzepatide) currently lead the market, driving strong sales growth.

Now, smaller biotech firms and established pharmaceutical companies are developing alternative mechanisms, longer-lasting formulations, and oral drugs to broaden patient access. “The obesity drug pipeline is growing, and many new therapies are expected to reach the market in the next decade,” said Costanza Alciati, Pharma Analyst at GlobalData, a data analytics and consulting firm. “This will offer more treatment options for patients, provided that access issues are addressed.”

Obesity rates continue to rise globally, with GlobalData forecasting a 0.7% annual increase in prevalence across seven major markets through 2031. While lifestyle interventions remain the first line of defence, pharmacotherapy is increasingly prescribed alongside diet and exercise. As a result, obesity drug sales could surge from $37.2 billion in 2023 to $173.5 billion by 2031.

Novo Nordisk and Eli Lilly currently control 99% of the market, but their dominance may weaken as new entrants introduce alternative therapies. GlobalData projects their combined market share could drop to 78% by 2030, with over 300 GLP-1 receptor agonists in development. Wegovy is available in the US, Denmark, Norway, Germany, and the UK, with launches in Japan and other European markets expected in 2024. Zepbound, which received US FDA approval in November 2023, is set for wider global expansion this year, with anticipated approvals in Europe, Canada, and parts of Asia.

“Novo Nordisk has been researching obesity treatments for 25 years. Today, only two companies—Novo Nordisk and Eli Lilly—have anti-obesity products on the market, but more companies will enter the space. This has happened before in the diabetes market, where we sometimes had many competitors and, at other times, fewer. Ultimately, it comes down to innovation,” said Camilla Sylvest, Executive Vice President, Commercial Strategy & Corporate Affairs at Novo Nordisk.

“Despite efforts to scale production, demand still outpaces supply. Looking ahead, we expect the market to evolve into different segments: high-efficacy treatments for significant weight loss, convenience-focused oral therapies, and price-sensitive options for broader accessibility. We aim to compete across all these segments with a strong obesity portfolio,” she added.

American biotech firm Viking Therapeutics is developing VK-2735, a dual GLP-1/GIP receptor agonist in Phase II trials. If approved, it could become the first oral GLP-1 obesity drug by 2028, with projected sales of $2 billion by 2030. Similarly, Altimmune is advancing pemvidutide, now in Phase II trials for obesity and metabolic dysfunction-associated steatohepatitis (MASH). Expected to launch in 2027, it could generate $1.2 billion in sales by 2030. US-China biotech firm Structure Therapeutics is working on GSBR-1290, an oral GLP-1 candidate targeting obesity and type 2 diabetes, expected to hit the market by 2028 with $1.2 billion in projected revenue.

“These smaller players may not have the same scale as Novo Nordisk and Eli Lilly, but their approaches to weight-loss treatment could establish them as significant competitors over the next decade,” said Jasper Morley, Pharma Analyst at GlobalData.

American pharma company Amgen is also developing MariTide (maridebart cafraglutide), which has shown up to 20% weight loss in clinical trials. Unlike weekly GLP-1 injections, MariTide could be administered monthly, improving adherence.

Boehringer Ingelheim’s Survodutide (glucagon/GLP-1) is emerging as another strong contender. According to IQVIA Healthcare, it is the “first serious competitor” outside the Novo Nordisk-Lilly duopoly. Further, Indian pharmaceutical company Mankind Pharma is pursuing an oral GPR119-targeting drug for obesity. “We have seen encouraging Phase I results and recently started Phase II trials in Australia,” said Arjun Juneja, COO of Mankind Pharma.