Weight-loss drugs: Can Ozempic and other drugs change the landscape of India's wellness industry?

On Christmas Day, when Tesla CEO Elon Musk posed as a slim Santa Claus on X, he gave an unmatched public profile to the anti-obesity drugs Mounjaro and Ozempic with one comment. “Like Cocaine Bear, but Santa and Ozempic,” he said, adding, “Technically, Mounjaro, but that does not have the same ring to it.” The sudden publicity (Musk has 209 million followers on X) was the icing on the cake. The companies that make these two drugs, Eli Lilly of the US (Mounjaro) and Novo Nordisk of Denmark (Ozempic) are already the darlings of shareholders, with Eli Lilly at No. 13 and Novo Nordisk at No. 25 on a market capitalisation listing. Musk’s Tesla was at No. 8. So why are people going nuts over these drugs? Cut to a close shot of aam aadmi and obesity. Over 2,000 km from Austin, Texas, where Musk is headquartered, Savita Ahuja, a corporate lawyer based in Miami, Florida, was setting new goals after realising the impact of the new injection: She had lost 13 kg in 10 weeks. Savita, 34, had been on a roller coaster of coffee and junk food, odd hours, and sporadic workouts, with guilt trips into keto and intermittent fasting. But the 5’5” Savita had been stuck at 90 kg. Till she tried the new weight-loss injection. She couldn’t wait to share the news with her cousin in India. Her 80 kg cousin had tried every pill, powder, and belt sold on TV shopping channels to lose weight. The cousin’s first question: when would Savita’s drug be available in India? The cousin won’t have to wait long, as the pharma majors race to grab a global market expected to be worth $100 billion by the decade’s end. In 2023, Novo Nordisk, which makes semaglutide (marketed as Wegovy for weight loss and Ozempic for diabetes), briefly became Europe’s most valuable company with a market capitalisation of $424.7 billion, overtaking luxury goods major LVMH and even topping Denmark’s GDP. Novo Nordisk’s semaglutide and Eli Lilly’s tirzepatide, marketed as Mounjaro, are the rock stars of the pharma market and are eyeing an India entry in the next four-five quarters. Both were developed for managing Type 2 diabetes, in which the body does not produce enough insulin, the hormone that keeps you healthy by shunting excess sugar that floods your blood after a meal into your cells. 2025: A Happy New You Both semaglutide and tirzepatide target the GLP-1 receptor on cell surfaces and mimic the action of GLP-1 to get the body to produce more insulin, curb hunger and slow food movement from the stomach to the small intestine. In short, you feel less hungry and more full. The result: you lose weight. Clinical trials have shown participants losing up to 20% of their body weight. Four GLP-1 receptor agonists have been approved for obesity treatment: Novo Nordisk’s Wegovy and Saxenda, Eli Lilly’s Zepbound, and Shanghai Benemae Pharmaceutical’s Yishengtai. All these are injectibles. The good news for India is that Eli Lilly plans to introduce tirzepatide for Type 2 diabetes and weight loss here under its Mounjaro brand this year. It has already got approval from the Central Drugs Standard Control Organisation (CDSCO). In December 2024, the Subject Expert Committee (SEC) recommended granting permission for the import and marketing of the tirzepatide Multi Dose Pen. According to SEC minutes, Eli Lilly must submit its Phase IV trial protocol to CDSCO within three months of approval. Meanwhile, Novo Nordisk’s entry is expected in 2026. Vineet Gupta, Associate Vice President and MD of Eli Lilly (India), says the country remains an important market for Lilly. “We are committed to accelerating the process of bringing our innovative products to the country. We aim to launch tirzepatide in India in 2025 after obtaining all necessary regulatory approvals,” he says. Elon Musk’s post on using weight-loss drugs related comorbidities created a buzz about the productsIn June 2024, the SEC recommended approving tirzepatide for import and marketing. This applies to six doses in single-dose prefilled pens and vials, subject to the condition that Phase IV clinical trials are conducted and quality and manufacturing requirements are met. Tirzepatide has already been approved for weight management and as an adjunct to diet and exercise for Type 2 diabetes in the US and the European Union. The Big Fat Numbers IQVIA, a contract research firm, says in its Global Use of Medicines 2023 report that the top therapeutic areas seen driving pharmaceutical spending globally by 2026 are oncology, immunology, diabetes, and cardiovascular and respiratory, in that order. But while obesity is ranked a lowly 19 by absolute spending, only oncology and obesity have a five-year compound annual growth rate or CAGR (2023-2027) in double digits. Oncology is 13-16% and obesity is 13-16%. The others are in low single digits. Obesity and diabetes have become significant public health challenges in India. The World Health Organization (WHO) says nearly 40% of Indian adults are overweight or obese. (You are overweight if your BMI is greater than or equal to 25 and obese if your BMI is greater than or equal to 30.) The National Family Health Survey V, done from 2019-21, found that 22.9% of men were overweight against 18.9% in NFHS-IV (2015-16), an increase of four percentage points. Then there is diabetes, which is linked to obesity. A study published in The Lancet estimates 101 million Indians—about 11.4% of the population—are living with diabetes. The Indian Council of Medical Research’s INDIAB study reported that 77 million individuals aged 18 and above are affected by Type 2 diabetes, with nearly 25 million being prediabetic. This number is expected to reach 134 million by 2045, according to the International Diabetes Federation (IDF). Dr Anoop Misra, Chairman of Fortis C-DOC Hospital for Diabetes and Allied Sciences and Director of the National Diabetes Obesity and Cholesterol Foundation (NDOC), says, “Poor dietary choices, lack of physical activity, and urbanisation are contributing to this growing health crisis. Obesity is a major factor in the rise of diabetes, cardiovascular diseases, and fatty liver disorders, which are further straining India’s healthcare system.” According to IMARC Group, the weight management market in India was valued at approximately Rs 1.73 lakh crore in 2023 and is projected to reach Rs 3.99 lakh crore by 2032, growing at a CAGR of 9.3% from 2024 to 2032. The market includes various segments, such as weight-loss supplements, fitness products, surgical treatments, and services, with dietary products, particularly weight-loss powders, being the largest revenue-generating segment. Pills are expected to be the fastest-growing category during the forecast period. Doctors have said that existing solutions, such as lifestyle changes or bariatric surgery, have had limited success in addressing this issue on a large scale. While medications like metformin and liraglutide (Victoza) provide some benefits, they have not been enough to stem the obesity crisis. A spokesperson from Novo Nordisk highlights the significant health burden in India: “With a population of 254 million individuals living with obesity, there is a need for better treatment and management strategies. Improving awareness and access to care will be important for improving health outcomes.” Novo Nordisk is working to expand access to its treatments in India, with plans to introduce semaglutide injections at a 2.4 mg dose for weight management. The company also emphasises the importance of addressing India’s cultural and dietary habits when providing solutions and overcoming the stigma surrounding obesity. In plain speak: how does one tackle Indians’ fondness for gulab jamun, rosogolla, and samosa? Eli Lilly’s Gupta highlights the need to recognise obesity as a chronic condition that requires comprehensive care. “It is important that obesity is viewed in the same way as other chronic diseases and that people living with obesity can access comprehensive care that can prevent and treat obesity. This includes lifestyle regimens such as diet and exercise, obesity management medications, and bariatric surgery,” Gupta says. Currently, weight-loss medications in India are limited to options like Orlistat and Liraglutide. Orlistat, an anti-obesity drug, has been available in India since the early 2000s. It works by inhibiting the absorption of dietary fats in the intestine. Metformin, a diabetes medication, helps with weight management by improving insulin sensitivity and lowering blood sugar. Liraglutide, originally developed for diabetes, is used off-label at lower doses to assist with weight loss. Liraglutide for weight loss became available in India around 2017. They have been used in India as part of weight-loss programmes, especially in the context of diabetes, but the newer stars are semaglutide and tirzepatide. Reach for the Stars? As Eli Lilly and Novo Nordisk prepare to launch their weight-loss treatments in India, cost is a big worry. In the US, Wegovy costs around $1,000 monthly, making it unaffordable for most patients. A big downside: you can’t stop taking it; most of your lost weight will return. They can become affordable in India only if the pricing is adjusted, possibly through partnerships with generic manufacturers like Cipla or Sun Pharma. This is where local pharmaceutical companies such as Dr. Reddy’s Laboratories, Lupin, Zydus Cadila, and Sun Pharma can get into the act. And they are. Dr. Reddy’s Laboratories has received approval to conduct a bioequivalence study on semaglutide, while Zydus Cadila is developing its obesity treatment candidates. Sun Pharma is working on GL0034, a long-acting GLP-1 receptor agonist for obese and non-obese adults without diabetes, which has shown positive results in early trials. Dr. Reddy’s Laboratories plans to expand its portfolio to include around 15 GLP-1 drugs, with different timelines for their development and release. Biocon’s Executive Chairperson, Kiran Mazumdar-Shaw, has a word for the dual health crises of diabetes and obesity: Diabesity. She highlights Biocon’s unique position in offering a combination of insulins and GLP-1 receptor agonists and says, “Even in the biosimilars space, we are highly differentiated as the only company developing biosimilar insulins.” “We’re already developing GLP-1s and achieved the first-ever approval for a GLP-1 peptide, liraglutide, in the UK. With semaglutide [Ozempic] going off-patent in emerging markets and Canada by 2026, there are immense opportunities. However, success will hinge on scale—not just in peptide production but also in developing the devices required to convert these into products,” she says. Biocon is also preparing to launch its liraglutide products in various regions as the drug goes off-patent in many parts of the world. Meanwhile, semaglutide, a once-weekly injection, represents the next generation of GLP-1s, with Novo Nordisk moving towards a monthly injection. Road Ahead: Not So Smooth Despite the promise of tirzepatide and semaglutide, their entry into the Indian market won’t be smooth: there are regulatory hurdles. In August 2024, the SEC reviewed Eli Lilly’s proposal to import and market a multi-dose prefilled pen version of tirzepatide, branded as KwikPen, with dosages between 2.5 mg and 15 mg. Tirzepatide had received approval in January 2024 for a single-dose prefilled pen format, as an adjunct to diet and exercise to improve glycaemic control in adults with Type 2 diabetes, but with the stipulation that Eli Lilly conduct Phase IV clinical trials in India. Although Phase III trials for tirzepatide and semaglutide elsewhere have shown positive results, Indian authorities require domestic clinical data. So these drugs may take two to three years to become widely available in India after their global launch, according to doctors. Then there are ethical concerns. Experts worry they could be misused for cosmetic weight loss rather than for managing clinical obesity. “Bariatric surgery remains the gold standard for some obese patients. We need awareness campaigns to ensure the drugs are used responsibly,” says Dr Pradeep Chowbey, Chairman, Max Institute of Laparoscopic, Endoscopic, Bariatric Surgery &amp; Allied Surgical Specialities. Tirzepatide has already been approved for weight management and Type 2 diabetes, in combination with diet and exercise, in the US and EU. In the US, the list price for a one-month supply is around $1,087 (the exact price depends on insurance coverage, etc). Eli Lilly has not notified the probable price of tirzepatide in India, but it may do so this year after the regulator clears it. “The current cost of semaglutide in India is approximately Rs 10,000 per month. Tirzepatide will likely be priced similarly or higher, although the company can only confirm the exact price,” says Dr Misra of Fortis C-Doc. The potential for weight-loss medications such as semaglutide and tirzepatide to become mass treatments in India depends on cost and public demand, and they have to be cleared by the Drugs Controller General of India. If these drugs are shown to be cost-effective in preventing chronic diseases such as diabetes, hypertension, and cardiovascular conditions, there could be increased pressure for their inclusion in public health programmes or for private health insurers to offer coverage. @neetu_csharma

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Weight-loss drugs: Can Ozempic and other drugs change the landscape of India's wellness industry?