Popular weight management drugs like Ozempic only come in injectable form, but losing weight may soon be as easy as swallowing a pill.
A slew of biopharmaceutical companies are working to create a pill version of a glucagon-like peptide 1 (GLP-1) receptor agonist, which would work similarly to other medications in this category, such as Zepbound and Mounjaro.
Some companies, including Viking Therapeutics and AstraZeneca, recently announced promising results from clinical trials examining the safety and efficacy of pills in the early stages of development.
Below, experts discuss the development of new GLP-1 pills, including their potential benefits and downsides.
To date, all GLP-1 medications for weight loss are injectables that people have to take weekly. The FDA has approved one GLP-1 pill, Rybelsus, but only for people with type 2 diabetes, Reshmi Srinath, MD, an associate professor of medicine and director of the Weight and Metabolism Management Program at the Icahn School of Medicine at Mount Sinai, told Health.
Many manufacturers, including Pfizer, Novo Nordisk, Roche, Structure Therapeutics, and Terns Pharmaceuticals, have stepped in to fill the gap. Viking Therapeutics and AstraZeneca, both of which released data about their pills in early November, are also in the mix.
Like the drugs Mounjaro and Zepbound, Viking’s pill, VK2735, targets both GLP-1 and GIP receptors. According to Viking’s findings, 92 obese participants taking the once-daily pill lost up to 8.2% of their body weight after 28 days. About a third of people reported mild nausea, and 11% said they experienced nausea or diarrhea.
Srinath said the results were impressive because doctors specializing in weight loss typically hope their patients see a 5% loss over the course of months. “This is all very new data, [but] the results are very exciting,” she said.
AstraZeneca’s oral medication, AZD5004, also appears to show promise. Early data found that after four weeks of daily use, 51 people with type 2 diabetes lost an average of 5.8% of their body weight. The drug had no serious side effects for people who were either healthy or had type 2 diabetes, but 70% of people experienced gastrointestinal symptoms, especially at higher doses, compared to 54% of people taking a placebo.
It’s too soon to say which oral medication may be approved first or when any of them might become available to the public. “We need longer studies evaluating up to a year of data,” Srinath said.
Experts said one of the most significant changes oral GLP-1s might bring to the weight loss drug market is greater accessibility. Regarding cost, “this could have a really huge role,” Srinath said.
Oral tablets may be cheaper for manufacturers and, therefore, more affordable for consumers. Right now, many people who would benefit from an injectable GLP-1 medication can’t afford it.
“These drugs are expensive, and insurance companies are pushing back and limiting coverage,” Srinath said. “They’re trying to create barriers [to access]. That’s where a pill formulation [comes into play.] If this would be a cheaper option where weight loss would be comparable, that would be a huge opportunity for patients.”
Tablets may also be more palatable for people who dislike injectables, W. Scott Butsch, MD, MSc, director of obesity medicine at the Bariatric and Metabolic Institute at Cleveland Clinic, told Health.
If many people start taking the pills instead of the injectables, that could also benefit the environment, Butsch said, as the injectors won’t need to be produced in large quantities.
Though some people may prefer taking a pill compared to using an injectable, others may opt for the once-a-week injectable rather than pills like Viking’s, which have to be taken daily.
Some patients report difficulty remembering to take something every day, and for them, “it’s easier to take the weekly injection,” Butsch said.
While historically, people have been hesitant to use injectables, that has changed as the popularity of currently approved GLP-1 injectables has skyrocketed in recent years. “Quite honestly, even the weekly injections weren’t as popular,” Butsch said, “but now that these drugs are more efficacious, we’re seeing people more than willing to inject themselves.”
Another issue is that, like injectables, many of the pills will still likely come with a risk of side effects, such as nausea, vomiting, and diarrhea, Srinath said. She added that people who take Rybelsus, the oral GLP-1 drug for diabetes, have reported experiencing side effects similar to those experienced by people who use injectable GLP-1s.
So while some people may be eager to try a pill rather than an injectable, some deterrents, like potential side effects, may still cause hesitation for others.