In recent years, the emergence of the incretin drug class has revolutionised the cardiometabolic treatment space, as doctors increasingly prescribe weight loss medications for the long-term management of obesity and its associated comorbidities.
At the epicentre of this movement are pharma giants, Eli Lilly and Novo Nordisk, which have made history as of late by commercialising two of the most successful drugs in pharma history – Zepbound/Mounjaro (tirzepatide) and Wegovy/Ozempic (semaglutide). In Q3 2026, tirzepatide sales alone for Lilly were higher than some big pharma company’s entire takings for the quarter, showing the huge demand for these kinds of drugs.
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While these therapies marked the start of the incretin class’s rise to fame, both companies have been battling it out to claim glory with their next-generation therapies – with Lilly’s investigational ‘triple G’ agonist, retatrutide, offering “bariatric surgery-like weight loss efficacy” in recent late-stage trials.
Now that drugs with strong weight loss efficacy are thriving on the market, many are wondering where the obesity field will go next, as companies look to grab a slice of a segment that a recent GlobalData report estimates will be worth $118.2bn in 2035.
At a panel session at the 2026 BIO-Europe conference in Cologne, Germany, which took place from 9 to 11 November, experts spoke of a renewed focus in the cardiometabolic space as treatment priorities shift.
While the segment’s interest has traditionally been on the weight loss efficacy of available therapies, Hamza Bokhari, executive director of preclinical strategy and business development at Swedish biotech Atrogi, noted that people are now looking at the quality of weight loss, as well as the tolerability and durability of effect a therapy can offer.
Drugmakers are also increasingly focusing on combining incretin therapies with other mechanisms of action (MOAs), such as amylin-based therapies, which Willem Broekaert, managing partner at V-Bio Ventures, mentioned could help address unmet needs in groups such as treatment non-responders.
Meanwhile, Hellmut Augustin, DVM, PhD, director of the Helmholtz Institute for Translational AngioCardioScience, tells Pharmaceutical Technology that the cardiometabolic space would likely benefit from targeting adipose tissue directly, as finding therapies to protect organs impacted by complications of cardiometabolic disease could represent a positive step forward.
“Mitochondrial function is one of the major targets,” Augustin said, adding that energy expenditure and lipolysis could also be fruitful areas for development.
Considering best practices for running cardiometabolic trials
During the panel session, experts were also keen to talk about cardiometabolic clinical trials, which can face notable challenges from patient retention to determining suitable endpoints.
One hurdle that Olivia Cavlan, partner at LifeArc, a British self-funded medical research organisation, pointed to was trying to design a proof-of-concept endpoint for trials to measure functional benefit when testing a muscle-sparing therapy in the context of obesity treatment.
According to Bokhari, this requires a sponsor to determine what they mean by muscle function – whether that be discussing power, strength endurance or a composite score, and there is currently no consensus agreement on which is the best to use.
Outside of this, Philip Brainin, CEO of IsoMab, a UK biotech, noted that it may be time to question if cardiovascular outcome trials are always needed. “I see regulators becoming more patient-centric as a trend,” he commented, adding that quality of life matters more now than ever. To back this up, he highlights the US approval of Bristol Myers Squibb’s (BMS) Camzyos (mavacamten) in hypertrophic cardiomyopathy based on measures of exercise capacity in a non-outcome trial.
“You can come at this in a symptom-driven way,” Brainin commented, adding that if a drug produces symptoms that are meaningful to patients, then it’s possible that a company can run a pre-concept trial with less than 200 patients in six months, rather than the years it may take to run an outcomes trial.
This, Brainin said, would likely be more doable when liaising with the cardiorenal division of the US Food and Drug Administration (FDA), which he says is “more open for discussions” than the divisions in charge of obesity and diabetes, which generally only accepts body weight reductions over changes like shifts in body composition.
However, Brainin stressed that this was not him wanting to get rid of outcomes studies, as he believes they would be highly beneficial in the post-marketing setting. “Biotechs can push regulatory interactions; dare to ask questions, but with a data-driven approach,” Brainin concluded.
