The GLP -1 Class of Therapeutics is Set to Explode | AMCP 2024

Douglas M. Long

Sales of GLP-1 therapies have grown by 58% in 2023 compared with 2022, with the diabetes drugs Ozempic (semaglutide) and Mounjaro (tirzepatide) driving most of the volume growth, according to data presented by Douglas M. Long, BA, MBA, vice president of industry relations at IQVIA, at the annual meeting of the Academy of Managed Care Pharmacy in New Orleans.

Antidiabetes drugs are among the largest therapeutic category by sales, accounting for 18% of all non-discounted U.S. sales of prescription drugs in 2023, according to IQVIA’s latest data. Sales of Ozempic specifically have grown 78.7%; Ozempic comes in behind Humira as second best-selling drug in 2023. Ozempic and Mounjaro have the greatest absolute sales gains in 2023.

“The GLP-1 represent the highest percentage for the non-insulin diabetes market,” Long said.

Going forward, spending on the GLP-1 class of therapeutics is expected to grow by 378% to $8.1 billion by 2027. Increased attention has been on the GLP-1 class of medications after semaglutide was approved as Wegovy and tirzepatide as Zepbound to treat obesity. IQVIA expects two to five additional launches of GLP-1 therapies by 2027.

“In the United States, 40% of the population is overweight or obese,” Long said. “Louisiana, Oklahoma, and West Virginia are the three states with the highest percentage of self-reported among adults. Vermont, Colorado and California are the states with the least of obesity but even that even those states, people are much more obese than they were in 2011.”

He indicates the issues with persistence of therapy and the need for patient support program, but said patients could be taking GLP-1 therapies for obesity long term. “If you're diabetic, you’re on diabetes medication for the rest of your life. So it is not too weird to think that about being on weight loss drugs for the rest of your life.”

The pipeline for obesity medications full, with more than 120 medications in development from preclinical to phase 3. One third of these are oral medications. But Long said the jury is still out on whether oral medications offer the same efficacy and tolerability.

As more data becomes available about how GLP-1 therapies impact the metabolic system, demand and use is expected to grow. Obesity is associated with type 2 diabetes, cardiovascular disease, the fatty liver disease nonalcoholic steatohepatitis (NASH) and chronic kidney disease.

Research is ongoing about how GLP-1 treatment can impact these conditions. GLP-1 agonists have been used off label to treat patients with NASH. Additional indications for semaglutide and tirzepatide expected to increase the demand for and use of the GLP-1 therapies.

For example, Wegovy was recently approved to reduce the risk of cardiovascular death, heart attack and stroke in overweight patients with heart disease. Just last month, CMS announced that Medicare can provide coverage for Wegovy for the use to reduce to reduce the risk of cardiovascular death in those who are obese.

Just this week, Lilly announced data from a phase 3 trial showing that tirzepatide reduced sleep apnea severity by up to almost two-thirds in those with obstructive sleep apnea and obesity. Sleep apnea affect about 80 million adults in the United States and can have serious complications. It can contribute to hypertension, coronary heart disease, stroke, heart failure, atrial fibrillation and type 2 diabetes.