The emerging contest to dominate the market for oral tablets in obesity treatment became clear this week as news and PR dispatches flowed from EASD in Vienna.

Aiming for a Mass Target

With understated confidence, Lilly presented and published pivotal phase three data on orforglipron in NEJM. They did not run from the fact that this small-molecule form of a GLP-1 agonist does not deliver the same potency as an injection. From Lilly’s perspective, that’s not the point. Rather, they are aiming to launch a convenient oral tablet for the masses.

Promising Effectiveness

Looking for an edge, Novo Nordisk presented and published obesity data on their high-dose oral semaglutide – also in NEJM. But in their PR, they pushed a little harder on the efficacy claims. Calling it “Wegovy in a pill,” they claimed 16.6% weight loss – even though the number you’ll find in the study abstract is 13.6%. There are many ways to slice these numbers. So in their press release, Novo chose to emphasize data from people who adhered to the treatment. This excludes people who did not or could not keep taking it as intended and thus yields higher numbers.

Head-to-Head Data

The difference in strategies is obvious. Novo is angling to say their tablet has effectiveness that is “comparable” to injectable Wegovy. Lilly is not stressing comparisons to injectables. Rather, the company simply says that the effectiveness is “meaningful.”

However, lest we make the mistake of assuming oral semaglutide has an effectiveness advantage, Lilly announced topline results for a head-to-head study of orforglipron versus oral semaglutide for type-2 diabetes. Orforglipron produced superior results, both in terms of glycemic control and weight reduction. Of course, this comparison is not the final word for effectiveness in obesity treatment. The doses of oral semaglutide are the lower doses used for diabetes.

It remains to be seen which of these promising oral tablets will wind up on top in the obesity market. That will be the real test of which product brings the greatest value.

Click here and here for the NEJM publications on oral semaglutide and orforglipron. For the Lilly press release on toplines for the head-to-head study in diabetes, click here. For further perspective, click here, here, and here.

Taking a Tablet, illustration created with Gemini image generation