CT-388

None With the obesity market projected to exceed $130 billion by 2034, many major pharmaceutical players are rapidly advancing pipelines to capitalize on what is arguably the most dynamic space in the industry. To identify the companies positioned to outperform, FENIX has created the Obesity Power Rankings of the Top 10 players. For context, >20 companies were assessed across more than 15 weighted criteria, including pipeline depth, clinical differentiation, and commercial infrastructure, to derive a composite score out of five. If you’re interested in a deeper look at the full assessment framework, please contact the FENIX team. Below, FENIX outlines the rationale for all rankings and highlights key headwinds and tailwinds that shape each company’s position:   Lilly (4.9/5): Lilly remains the undisputed market leader in obesity, as evidenced by its tirzepatide franchise becoming the world’s top-selling drug in 2025, surpassing Merck’s Keytruda to generate >$36 billion in annual revenue. While Lilly possesses a robust late-stage pipeline which is anticipated to help defend its leadership position, near-term momentum is expected to center on the orforglipron launch in Q2 2026. Considering Novo’s Wegovy Pill appears to hold a marginal edge in terms of efficacy, Lilly’s commercial team may need, for once, to come from behind. Novo Nordisk (4.8/5): Having effectively pioneered the modern obesity market with semaglutide, Novo entered 2026 confronting a convergence of executional challenges and a visible decline in innovation, factors that culminated in the company issuing its first negative annual sales outlook since semaglutide’s ascent. Novo now relies on strong launches of injectable 7.2mg Wegovy, Wegovy Pill, and CagriSema to stabilize its US market share and rebuild investor confidence. While these launches may alleviate near-term pressures, it remains uncertain whether Novo has truly identified a long-term successor to semaglutide. Pfizer (4.1/5): Following its $10 billion Metsera acquisition and licensing agreement with YaoPharma in 2025, Pfizer has significantly vaulted up the competitive rankings. While the company previously faced multiple setbacks in obesity (e.g., danuglipron and lotiglipron discontinuations), Pfizer finally appears to have assembled a differentiated pipeline that can fully leverage its established commercial and manufacturing infrastructure. Roche (4.0/5): Despite its historically limited presence in the cardiometabolic space, Roche has publicly emphasized its ambition to become a Top 3 player in the obesity market. Following the recent encouraging topline CT‑388 Phase 2 results, attention now turns to the upcoming Phase 2 petrelintide readout in H1 2026, a pivotal catalyst that will likely shape the trajectory of its partnership with Zealand and, ultimately, Roche’s broader obesity aspirations.  AstraZeneca (3.6/5): A compelling case can be made that AZ has the pipeline depth to emerge as a dark horse contender for the third-place position in the power rankings. The company quietly advanced a broad mid-stage pipeline throughout 2025; and with multiple Phase 2 readouts expected in 2026, it's licensing agreement with CSPC Pharmaceuticals, which added a monthly dual agonist to its arsenal, further strengthens it as a serious contender.  Amgen (3.3/5): Amgen is effectively placing a concentrated bet that MariTide’s extended dosing will be its key differentiator in the future obesity market. While quarterly maintenance dosing is differentiated, it remains to be seen whether the company can overcome the Phase 2 tolerability issues that unsettled investors at ADA 2025. Boehringer Ingelheim (3.0/5): With data from the Phase 3 survodutide program anticipated to begin reading out in H1 2026, BI is set to become the first challenger to the current Lilly+Novo duopoly. Even with positive Phase 3 survodutide data, BI likely needs to expand its pipeline beyond its Phase 2 triple agonist to become a long-term competitive player in the space. Regeneron (2.9/5): While it was previously believed Regeneron was taking a tangential approach in the obesity market, looking to develop lean mass-sparing assets, its in-licensing deal for olatorepatide in June 2025 revealed the company’s broader obesity ambitions. However, similar to both BI and Amgen, it is believed Regeneron also needs to further diversify its portfolio to be considered a future leader in obesity. Zealand Pharma (2.4/5): Zealand, guided by CEO Adam Steenburg’s ambition to end what he describes as the “Weight Loss Olympics,” is making a strategic bet that amylin will become the next foundational anti-obesity class. Following Zealand’s partnership with Roche for petrelintide, the upcoming Phase 2 ZUPREME-1 readout will offer the first meaningful look into whether petrelintide lives up to the TPP promise. Kailera Therapeutics (2.2/5): Having licensed China-based Hengrui’s GLP-1/GIP dual agonist (ribupatide), which has already demonstrated strong late-stage weight loss efficacy in a Chinese population, Kailera initiated its own Phase 3 program evaluating higher doses (>6 mg) over longer treatment durations. It will be interesting to see if Kailera follows the traditional path of partnering with Big Pharma or if it goes alone with a new US commercial model (i.e., solely direct-to-patient).

前言PREFACE 2026年2月2日，诺和诺德正式公布双机制药物CagriSema的REIMAGINE III期临床试验结果。这款融合GLP-1与amylin双重作用机制的创新药物，在血糖控制与体重管理两大核心指标上显著优于自家王牌产品Wegovy（司美格鲁肽），不仅为减重与降糖治疗带来新选择，更让本就白热化的全球减重药赛道竞争进入新阶段，引发行业对“减重王座”归属的深度热议。 CagriSema：双机制协同 PART 01 1 核心机制：GLP-1与amylin的“双剑合璧” CagriSema是诺和诺德打造的复方创新药，其核心优势在于将Wegovy/Ozempic的关键成分：GLP-1受体激动剂司美格鲁肽（semaglutide）与长效胰淀素（amylin）类似物卡格列汀（cagrilintide）进行组合。 其中，amylin作为胰腺分泌的天然激素，能精准模拟饱腹感、延缓胃排空，相比单纯GLP-1机制，对食欲的抑制作用更强劲，二者协同作用实现了“1+1＞2”的治疗效果。 2 试验数据：血糖与体重管理双突破 REIMAGINE 2作为一项为期68周的随机、双盲、多中心III期临床试验，共纳入2728名经二甲双胍治疗后血糖仍控制不佳的2型糖尿病患者，部分患者同时联合SGLT2抑制剂治疗。试验结果显示，CagriSema在核心疗效指标上全面超越司美格鲁肽单药。 血糖控制：按治疗效果评估，CagriSema（2.4mg/2.4mg）组HbA1c平均下降1.91个百分点（基线平均8.2%），而司美格鲁肽（2.4mg）组仅下降1.76个百分点；按治疗方案评估，CagriSema组HbA1c下降1.80个百分点，仍优于司美格鲁肽组的1.68个百分点。 体重管理：治疗效果评估中，CagriSema组平均体重下降14.2%，43%的患者实现≥15%减重，24%的患者减重≥20%；司美格鲁肽组平均减重仅10.2%；即便按治疗方案评估，CagriSema组减重12.9%，仍领先于司美格鲁肽组的9.2%。 尽管CagriSema表现亮眼，但与礼来Zepbound相比，仍存在小幅差距。诺和诺德计划于3月底公布CagriSema针对肥胖人群的头对头试验数据，这将成为其与竞品正面抗衡的关键一战。 3 安全性：耐受性与GLP-1类药物一致 CagriSema的不良事件以胃肠道反应为主，与GLP-1类药物已知的安全性特征保持一致，未观察到新的安全性信号。不过，由于amylin机制直接作用于饱腹感与胃排空过程，其胃肠道耐受性的详细数据（如不良反应发生比例、频次、严重程度等）尚未完全披露，疗效与耐受性的平衡将直接影响药物在真实世界的依从性。 赛道竞争白热化：巨头博弈与新势力突围 PART 02 1 诺和诺德：双产品布局巩固领先地位 在CagriSema推进临床的同时，诺和诺德于2026年1月推出口服版Wegovy并在美国开售，上市两周处方量即突破1.8万张。 口服剂型彻底打破了注射剂型对减重药市场的垄断，吸引了大量因抗拒注射而不愿用药的新患者，与CagriSema形成“口服+注射”“单机制+双机制”的产品矩阵，进一步巩固了其在赛道中的“领头羊”地位。 2 礼来：扩产+多靶点研发强势应战 作为诺和诺德的老对手，礼来并未放慢脚步。为应对激烈竞争并扩大产能，礼来已宣布投资35亿美元兴建新工厂，同时全力推进旗下三靶点减重药物retatrutide的研发与上市进程。凭借多靶点机制的潜在优势，礼来试图在市场中抢占更大份额，与诺和诺德形成直接抗衡。 3 罗氏：新势力突围，CT-388疗效惊艳 除了传统巨头，行业新势力也在加速崛起。2026年1月26日，罗氏公布其减重新药CT-388的II期临床试验数据，受试者平均体重减轻22.5%，疗效远超当前主流减重药。几乎同步，罗氏已启动CT-388的III期临床试验，剑指诺和诺德、礼来占据的“三巨头”宝座，有望进一步改写赛道竞争格局。 市场预期下调背后的多重挑战 PART 03 1 价格战加剧，利润空间持续压缩 GLP-1类药物的价格战已正式打响，目前相关药物现金价已跌至149美元/月，随着竞争加剧，价格下行压力持续增大，企业利润空间被不断压缩。 2 专利到期逼近，仿制药竞争压力显现 多款主流减重药的专利即将到期，仿制药企业已在积极布局。一旦专利保护失效，仿制药将大量涌入市场，原研药的竞争优势将逐渐弱化，市场份额面临被分流的风险。 3 口服剂型局限，赛道受众未能有效扩大 尽管口服Wegovy等剂型实现了“换量”，吸引了部分注射剂型的抵触者，但并未真正突破减重药的受众边界。 对于减重需求人群中的特殊群体（如合并多种基础疾病、对药物成分敏感者），现有剂型仍无法覆盖，赛道整体受众规模未能实现实质性扩张。 终局未定：减重药赛道的未来走向 PART 04 1 后续考验：耐受性与市场定位 CagriSema的III期数据虽展现优效性，但仍面临两大关键考验：一是胃肠道耐受性的详细数据披露，需明确不良反应的实际影响以提升患者依从性；二是清晰的市场定位，在双靶点、三靶点等高效药物不断涌现的背景下，若无法精准界定目标人群，其竞争优势可能被更亮眼的竞品数据掩盖。此外，其针对肥胖人群的头对头试验结果，将直接影响其在减重赛道的市场地位。 2 多机制竞争成关键 当前全球减重药赛道呈现“冷热交织”的态势：CagriSema的双机制突破、巨头的密集博弈推动赛道技术迭代，而市场隐忧的凸显则促使行业回归理性。未来，多靶点、新型作用机制将成为企业竞争的核心，药物的疗效、安全性、耐受性与成本控制将共同决定市场格局。 这场围绕“减重神药”的无硝烟战争，既见证了医药创新的蓬勃活力，也暴露了行业发展的现实挑战。随着更多临床试验数据的披露、新药物的上市以及市场环境的变化，减重药赛道的竞争将更加激烈。谁能最终坐稳“减重王座”，仍需时间给出答案，而赛道的持续进化，终将为全球减重需求人群带来更优质的治疗选择。