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GSK Plc’s shingles vaccine was linked to a longer delay in dementia onset than a competing shot, a finding that suggests superior protective powers against one of the world’s most threatening conditions.

People who received the Shingrix vaccine lived an average of 164 days longer without a dementia diagnosis than those who got Merck & Co.’s Zostavax, according to a study published Thursday in the Nature Medicine journal. The Merck vaccine was linked to lower dementia risk in a study last year.

More than 55 million people worldwide have dementia, the seventh leading cause of death among older people globally. While recently approved drugs like Eisai Co.’s Leqembi and Kisunla from Eli Lilly & Co. can help slow the progress of Alzheimer’s disease—one of the most common dementia forms—there is no cure.

Read More: Changing Your Diet and Lifestyle May Slow Down Alzheimer’s

“The next question is how does vaccination exert this dementia protection effect?” said Rob Howard, a professor of old age psychiatry at University College London who wasn’t involved in the study. It could be through reducing levels of the virus, or by affecting some mechanism of the disease itself, he said.

The study, conducted by scientists at the University of Oxford, included data from more than 200,000 people in the U.S. who had received one of the shots over the past decade. About half received Zostavax between October 2014 and September 2017, while others received Shingrix between November 2017 and October 2020. Zostavax, a live vaccine, has been largely discontinued in the U.S. in favor of Shingrix, a recombinant shot.

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The researchers followed subjects for six years after they received shots, comparing the prevalence of dementia diagnoses in both groups. The Shingrix shot delayed dementia longer in women than men. An earlier study of Zostavax found little impact on dementia in men at all.

The efficacy appears to be comparable to that seen in the new drugs for Alzheimer’s, said Andrew Doig, a professor of biochemistry at the University of Manchester. More studies might show whether there’s benefit in giving the shingles vaccine at younger ages, he said.

The findings should prompt further research about how exactly the protection could arise and should be confirmed in a large-scale, randomized control trial, the authors wrote.

Novo Nordisk A/S has a successor waiting in the wings for the generation of weight-loss shots it pioneered: a pill that helps people shed pounds without the drawbacks of an injection.

The medicine is the next frontier in the obesity fight, promising further billions in revenue, and Novo is leading once again. Trouble is, it can’t launch the drug widely without endangering its existing best-sellers.

The pill helps patients lose roughly as much weight as the blockbuster Wegovy. But the oral version requires far more of the same active ingredient, called semaglutide, and Novo already can’t make enough of it to meet demand.

That leaves Novo in a bind. Either it finds a way to further ramp up production or it curtails the pill’s launch, ceding ground to rivals rushing to develop competing products, like Eli Lilly & Co., Amgen Inc. and Pfizer Inc.

Chief Executive Officer Lars Fruergaard Jorgensen acknowledges that Novo underestimated the demand when it originally drew up plans for a pill. 

Now the company, which originally planned to apply for U.S. regulatory approval last year, has to consider how best to manage its limited semaglutide supply.

“It’s clear that when we make a tablet version and use semaglutide, we need to use a lot,” Jorgensen said in an interview on Wednesday in New York. “We cannot conquer the world with that technology as a template.”

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Novo has postponed a U.S. regulatory filing to this year and now says it will await the results of more clinical tests, including one investigating a lower-dose version that would require less of the active ingredient.

At stake is how to stay on top of the wave of obesity sales that has boosted Novo’s market value beyond $530 billion, making it Europe’s top company and a growth engine for the Danish economy. Shares of Novo rose nearly 2.5% Friday, and are up 72% in the past 12 months. 

Novo on Monday struck a deal to pay $11 billion for three factories as part of its shareholder Novo Holdings A/S’s acquisition of Catalent Inc. Jorgensen, in a Bloomberg Television interview, touted the transaction as a “huge opportunity to serve more patients” seeking treatment with Wegovy and its sister drug, the diabetes shot Ozempic.

Competition is heating up between Novo and Lilly, whose recently approved Zepbound is predicted to become the best-selling drug in history. An experimental weight-loss pill it’s developing moved last year into the last stage of clinical tests.

A tablet is the next milestone for a market that Bloomberg Intelligence analysts estimate will reach $80 billion by 2030. But it’s not the only consideration for drugmakers, who are also working on making next-generation treatments that trigger fewer side effects, require less frequent administration or minimize the muscle loss that can occur with rapid weight change. 

Lilly’s experimental pill is a different type of molecule from Novo’s that, at least in theory, should be easier to make and potentially cheaper, said Michael Shah, an analyst for Bloomberg Intelligence. It can also be taken with food, he said. In a survey, about a third of doctors told Shah and colleagues that they prescribe oral drugs before shots. While injecting Wegovy with a pen isn’t as complicated as some might think, “a pill would essentially open up the market,” Shah said.

Strongest dose

Volunteers taking the Novo pill alongside diet and exercise counseling lost about 17% of their body weight over 68 weeks in test results released last year. The medicine contained 50 milligrams of semaglutide, about 20 times as much as in the strongest dose of the weekly Wegovy injection.

Novo already sells a pill for diabetes under the name Rybelsus that uses less semaglutide than its experimental one — though still more than the shots — and whose annual revenue is about a fifth of Ozempic’s.

The Danish company has other pills in development. They include a drug acquired last year in the purchase of Inversago Pharma, which Jorgensen said could probably be made in much larger quantities. Another early-stage one works in a similar way to CagriSema, Novo’s experimental next-generation shot.

Different needs

While the drugmaker is proceeding on all these fronts, Jorgensen said that Novo may not need to sell an obesity pill widely to stay competitive.

Japan is an example of a market where a tablet is key, he said, because only specialists prescribe injected therapy. Novo has separate studies to test its pill in Asian patients. And in the US, he allowed, a daily pill will be a preferred option for some. But converting the entire market, with hundreds of millions of potential patients, will not be possible, the CEO said. The drugmaker’s market surveys suggest it isn’t necessary.

“The majority would say, ‘Well, I would prefer a tablet,’” Jorgensen said. “But if you give them the option of a weekly injection with the efficacy that semaglutide is bringing, that is very attractive.”

An experimental weight-loss shot from Amgen Inc.—taken less frequently than wildly popular treatments from Eli Lilly & Co. and Novo Nordisk A/S—appears to keep weight off even after patients stop taking it.

Patients given a monthly injection of Amgen’s drug, dubbed MariTide, lost up to 14.5% of their body weight in just 12 weeks, according to a small, early-stage study published Monday in the journal Nature Metabolism. And some people kept the weight off for up to 150 days after stopping the drug, findings show.

“That is really a remarkable and distinguishing characteristic of this molecule,” Narimon Honarpour, senior vice president of global development at Amgen, said in an interview.

Investors and analysts have been eagerly awaiting updates on Amgen’s shot since the Thousand Oaks, California-based company shared early results at a conference in 2022. The latest Nature Metabolism study offers the most detailed look yet at Amgen’s drug, which is now in mid-stage studies. Another readout is expected later this year.

Amgen’s drug works a bit differently than Wegovy or Zepbound. It’s what’s known as an antibody-drug conjugate, or ADC, a type of molecule more commonly used as a targeted cancer treatment. One part of the drug, an antibody, blocks the GIP receptor, while the other part, two peptides, mimics a gut hormone called GLP-1.

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“There’s something special about having them glued together the way they are on the same molecule,” said Saptarsi Haldar, vice president of cardiometabolic disorders at Amgen. The antibody component of the drug also allows it to stick around in the body longer than weekly weight-loss shots.

Amgen designed the drug specifically as a treatment for obesity, but is now testing it in patients with diabetes—the opposite of how weight-loss drugs came to be at Eli Lilly and Novo Nordisk. The decision to inhibit GIP, rather than mimic it like Eli Lilly’s Zepbound, was based on insights gleaned from its expertise in human genetics.

“Those genes told us loud and clear that decreased activity of the GIP receptor was associated with decreased BMI, or body-mass index,” Haldar said. 

Amgen’s study, which enrolled 110 patients with obesity, was intended to assess MariTide’s safety and tolerability, but it revealed the drug’s dramatic effects on weight. Patients in one group were randomly assigned to receive a single dose of MariTide and were followed for 150 days, while another group of patients were given a dose every four weeks for three months.

Patients who received a single shot of the highest dose had lost up to 8.2% of their body weight after 92 days, suggesting the drug has a prolonged weight-loss effect, according to the study. 

Safety and side effects were similar to other GLP-1 drugs, findings show. Nausea and vomiting were the most commonly reported side effects and typically lasted for about 72 hours. Four patients in a group receiving the highest dose of the drug withdrew before getting a second shot due to mild gastrointestinal issues, according to the study.

Although the early results are promising, more studies are needed before the drug reaches patients. Honarpour said the results of the company’s mid-stage study are an important next step. Still, Amgen sees ample opportunities for newcomers like itself to enter the obesity market, and is also working on an oral weight-loss drug with results expected in the first half of the year.