Boehringer and Zealand take a baby step in obesity

In March Boehringer Ingelheim and Zealand Pharma said they would start a phase 3 trial of their GLP-1/glucagon agonist BI 456906 in obesity, despite having not made phase 2 data on the project public. Today they released the headline figure from the mid-stage trial, with BI 456906 allowing 14.9% weight loss in overweight or obese patients after 46 weeks' treatment. This is roughly on a par with what Novo Nordisk’s Wegovy showed at a similar time point in its pivotal obesity trial. But Boehringer and Zealand have not released the weight loss figure for the placebo group in the phase 2 trial, making the true effect of BI 456906 hard to deduce. Moreover, Lilly’s Mounjaro remains the target to beat: though this agent is not yet approved in obesity, it appears to have outplayed both Wegovy and BI 456906 at 46 weeks on a cross-trial basis. But the real spectre at the feast is Altimmune’s pemvidutide. This has the same mechanism as BI 456906 and showed alarming toxicity in phase 2. BI 456906’s side effects will be scrutinised as closely as its efficacy when full data are presented at the annual meeting of the American Diabetes Association next month.

Wegovy and Mounjaro vs BI 456906: cross-trial comparison 
Company Novo Nordisk Lilly Boehringer Ingelheim/
Project and dose Wegovy 2.4mg Mounjaro 15mg (high dose) BI 456906, dose unknown
Mechanism GLP-1 analogue GIP/GLP-1 agonist GLP-1/glucagon agonist 
Trial Step 1 (Ph3, NCT03548935) Surmount-1 (Ph3, NCT04184622) Ph2, NCT04667377
Weight loss at 46wks with drug Approx 15% Approx 21% 15%
Weight loss at 46wks with placebo Approx 3% Approx 3% ?
Mounjaro efficacy data are efficacy estimands. Source: company communications & NEJM. 

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