At the 81st Scientific Sessions of the American Diabetes Association’s (ADA ) annual meeting, data was presented on a variety of antidiabetics that fall under the glucagon-like peptide 1 receptor agonist (GLP-1RA) umbrella. These included 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.

GlobalData believes that Eli Lilly and Novo Nordisk will continue to compete over the 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.

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 type 2 diabetes (T2D) market. The SURPASS-1 study was a 40-week, multi-centre, randomised, double-blind, parallel, placebo-controlled, Phase III trial in which tirzepatide (5mg, 10mg and 15mg) was shown to reduce haemoglobin A1c (HbA1c) by 2.07% and decrease weight by 11% compared with the placebo in T2D adult patients.

Of particular interest was the therapy’s ability to help patients achieve HbA1c levels within the normal range for non-diabetic individuals (lower than 5.7%). At the highest dose of 15mg, tirzepatide demonstrated additional benefits 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, a 40-week, multi-centre, randomised, parallel, open-label trial. Tirzepatide demonstrated reductions in both HbA1c and weight in T2D patients compared with 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 with Ozempic (semaglutide 1mg). The study met its primary endpoint, with Ozempic (semaglutide 2mg) reducing HbA1c by 2.2% compared with Ozempic (semaglutide 1mg) reducing HbA1c by 1.9%.

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

Key opinion leaders (KOLs) interviewed by GlobalData have 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 T2D patients with comorbidities and introducing the drug class earlier in the management of T2D. KOLs have also noted that the market is becoming increasingly crowded in a space that has already had one GLP-1RA, namely GlaxoSmithKline’s Tanzeum (albiglutide), taken off the market due to low sales stemming from the highly competitive market and issues surrounding the drug’s administration.