Danish drug group Novo Nordisk has announced structural changes, streamlining and job cuts in the company in order to focus the resources on the best growth opportunities instead of areas with little growth.

In its financial report for first half of 2018, the company also announces the termination of two phase I projects in the obesity pipeline. But according to CEO Lars Fruergaard Jørgensen, it does not mean that obesity becomes one of the segments with low priority.

"It doesn't mean that we scale down the activities in obesity. We had six phase I projects, and it was never the intention to take six projects to phase II and III. Some of the mechanisms overlap. It's a sign of our strength in research and development that we are able to identify a number of different mechanisms, test them in people in phase I and then appoint the winners," he says.

Various candidates

After a strategical evaluation of the obesity pipeline, Novo decided to terminate the two projects NN9499, an analogue of the protein FGF-21, and NN9030, an analogue of the hormone glucagon.

Like insulin, glucagon is produced in the pancreas, and the two hormones regulate the blood glucose balance. While insulin reduces the level of blood glocuse, glucagon can increase it again. Glucagon is therefore also used as emergency treatment for diabetics with too high levels of insulin.

Both Novo Nordisk and Zealand Pharma are developing glucagon-analogues to be used in a special pen for diabetics to treat severe hypoglycaemia. Zealand Pharma's candidate is in phase III and thus approaching the market while Novo concluded a phase I study with its candidate.

Yet, the drug group decided to discontinue the study with NN9030 against obesity. Instead, Novo puts its trust in the four remaining candidates in the obesity pipeline, where glucagon may still play a part.

Novo Nordisk is also developing a co-agonist with GLP-1 and glucagon and a tri-agonist with GLP-1, the glucagon receptor and the peptide GIP. Moreover, the company is testing the appetite-regulating hormone peptide YY - alone and in combination with the GLP-1 analogue semaglutide as well as a long-acting analogue of the hormone amylin.

An amazing opportunity

So, Novo Nordisk will continue the search for supplements to the already marketed obesity drug Saxenda (liraglutide) and the more potent GLP-1 molecule semaglutide, which is currently being tested in a large-scale phase III program in obesity.

"We think we have an amazing opportunity with semaglutide in obesity, which is in the late phase of development, and we think we have other opportunities to different mechanisms and potentially obtain a weight loss by up to 20 percent," says the CEO.

On several occasions, Novo Nordisk stated that a weight loss of that scale is necessary in order for medical treatment to become a real alternative to surgery, which is currently the best solution for very obese persons.

The company's only marketed obesity drug Saxenda holds the lion's share of the market and in the first six months of 2018, the product had a turnover of DKK 1.65 billion (USD 255 million) worldwide. That is a growth by 50 percent relative to same period last year measured in local currencies.

But despite the positive development for Saxenda, the medical alternative to surgery has still not had a real break-through. Globally, 650 million people suffer from obesity and only about two percent receive medical treatment.

So, as market leader, Novo Nordisk faces the enormous task of cultivating the obesity market and establish the infrastructure to benefit from the enormous potential.

"We are still optimistic regarding obesity treatment in the long run. We will continue to invest in obesity but we also have to ensure that it becomes a significant contribution to Novo Nordisk," says Fruergaard.

English Edit: Ida Løjmand

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