Eli Lilly's Orforglipron vs. Novo Nordisk's Oral Semaglutide: A Closer Look

Eli Lilly recently released top-line results from a head-to-head trial of its oral GLP-1 pill, orforglipron, compared to Novo Nordisk's oral version of semaglutide, and claimed superiority in treating type 2 diabetes. According to the press release, "In key secondary endpoints, orforglipron was also superior to oral semaglutide for weight loss." Neither pill is yet available for sale, but do the test results mean it's already game over in the battle between the two?

Eli Lilly's Trial Data

It's essential to never take the headline data of clinical trials as gospel, and that's especially relevant in this case. First, this head-to-head trial was aimed at lowering A1C levels (a measure of blood sugar), and, on this basis, the reported results do support the idea of superiority for Lilly's drug. For example, at the highest dosage of orforglipron (36mg), there was a 2.2% reduction in A1C compared to a 1.4% reduction in A1C in oral semaglutide at the highest dosage (14mg). However, data about the secondary endpoint of weight loss needs to be put into context. Eli Lilly claims that the highest dosage of orforglipron (36mg) produced an average weight loss of 9.2%, compared to a 5.3% reduction for the highest dosage (14mg) of oral semaglutide.

Context Matters

But here's the thing. Novo Nordisk is trialing oral semaglutide at a much higher dosage (25mg) in obesity than the 14mg dosage used in the Eli Lilly trial. In fact, Novo Nordisk recently released results from its Oasis 4 phase 3 trial in obesity at the 25mg dosage, reporting an average weight reduction of 16.6%.

The Takeaway

While the trial is good news for Eli Lilly in treating type 2 diabetes, it should not be taken as evidence of orforglipron winning out over oral semaglutide in terms of efficacy in the more lucrative obesity indication.

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