Global Biopharmaceuticals: Live from the Big Easy: T2D/Obesity KOL bullish on 2 step reta regimen (+LLY), amylin (+LLY/+ABBV), less so on QM dosing (=PFE/AMGN), oral PCSK9 could see strong uptake (+MRK)

Research evidence excerpt

Global Biopharmaceuticals: Live from the Big Easy: T2D/Obesity KOL bullish on 2 step reta regimen (+LLY), amylin (+LLY/+ABBV), less so on QM dosing (=PFE/AMGN), oral PCSK9 could see strong uptake (+MRK)

ed that there is “no paradigm” for preemptive low-dosing and it should be a

shared decision given the weight-regain trade-off.

•• Oral GLP-1 showed material market expansion despite launches are still in early

stage. Foundayo (orforglipron) just appeared in our KOL's EMR ~2 weeks ago and not on

many formularies yet. He viewed both Foundayo and oral Wegovy launches are still in early

days and awaited for titration and longer-term evaluation. Although our KOL was not very

confident on oral agents, cited Rybelsus experience, and stressed the fasting/administration

burden, and noted that almost 100% of target patients take other pills. He didn't view the

FDA's Phase 4 hepatic-safety requirement for Foundayo as an issue with experience from

statins, citing that "liver abnormalities were observed in almost every (statin)". Our KOL

expected oral agents to further expand market with GLP-1 naive patients with advantages in

cost of goods, storage and distribution, expanded access with lower price especially in self-

pay market.

•• Monthly or longer interval dosing was noted a hard sell. Our KOL viewed the monthly

dosing regimen untested in the commercial setting. Historically, monthly products sold

poorly in adjacent fields due to adherence issue. Semi-annual siRNA was noted to face the

buy-and-bill problem, which he considers a flawed model. He noted a greater preference

among cardiologists vs. endocrinologists, and cited PCSK9 siRNA (Leqvio) as the precedence.

•• Our KOL believed GLP-1 has a class effect to reduce liver fat (or MASH); diagnosis is the

bottleneck.