Price, potency and convenience: The hurdles facing Korea's future obesity drugs

Korea’s first domestically developed glucagon-like peptide-1 (GLP-1) obesity drug is nearing its debut, but experts question whether it will shake up the market. Hanmi Pharmaceutical’s Eppe Auto Injector faces tougher competition than Wegovy did at launch, and the drug will need a clear edge to win over consumers.

The government recently approved the Eppe Auto Injector, based on efpeglenatide, as Korea’s 45th developed compound.

Eppe’s biggest obstacle may be its price. Hanmi Pharmaceutical has not yet announced a price tag, but industry observers expect the injector to launch in the 100,000 won ($75) range. If those forecasts hold, Eppe would be more affordable than Wegovy, which starts at more than 200,000 won for a four-week supply.

“Pricing Eppe above the mid-100,000 won range could put it at a competitive disadvantage,” a pharmaceutical industry source said. “If the gap between [its price and] Wegovy’s is only 20,000 to 30,000 won, customers will have little incentive to choose Eppe.”

Mounjaro to lose, Eppe to maintain

In its Thursday sales forecast for Eppe, iM Securities estimated an annual treatment cost of $980, which translates to roughly 110,000 won a month. The report also cited a study of 288 patients who stopped undergoing obesity treatments, in which nearly half, or 47.6 percent, blamed costs or insurance coverage.

As a result, a competitive price could give Eppe a foothold in the market. Some users have floated the idea of losing weight with tirzepatide-based Mounjaro first before switching to Eppe, which will likely be cheaper, to keep the weight off.

“Given the cost of these drugs, [taking Mounjaro first before switching to Eppe] could be a viable approach,” said Oh Sang-woo, a professor of family medicine at Dongguk University Ilsan Hospital. “Until recently, it was popular to lose weight with Wegovy at first, then switch to the oral weight-loss drug Qsymia to keep it off.”

Eppe is entering a market in which Mounjaro and Wegovy already hold a commanding lead. Sales of prescription obesity drugs not covered by insurance totaled 450.2 billion won in Korea in the first quarter of this year, according to health care data company Iqvia.

GLP-1 injections captured 95.1 percent of the market over the cited period, with Mounjaro alone posting 323.2 billion won in sales — more than triple Wegovy’s 104 billion won.

Efficacy has become an increasingly fierce battleground for these weight loss drugs. In their respective pivotal trials, Wegovy produced an average weight loss of 14.9 percent after 68 weeks; Mounjaro recorded 20.9 percent after 72 weeks.

More recently, Eli Lilly’s next-generation obesity drug candidate, a combination of eloralintide and tirzepatide, achieved up to 23.3 percent over 48 weeks in a Phase 2b clinical trial, which evaluates dosing regimens in a large patient population to identify statistically significant results.

Eppe delivered an average weight loss of 9.02 percent over 40 weeks, though differences in trial design make direct comparisons of efficacy difficult.

Race to preserve muscle

The next frontier in obesity treatment is not simply how much weight patients lose but how much muscle they preserve. U.S.-based Regeneron Pharmaceuticals is developing a combination of semaglutide and trevogrumab, designed to limit muscle loss as consumers shed pounds.

A Phase 2 analysis found that the combination reduced thigh muscle loss by about 70 percent compared to semaglutide alone.

Meanwhile, petrelintide, an amylin-based drug developed by Roche and Zealand Pharma, achieved up to 10.7 percent weight loss over 42 weeks in a Phase 2 trial. Only 1.5 percent of patients discontinued the treatment because of gastrointestinal side effects.

Less hassle, more appeal

Convenience is yet another battleground. With supplies of Saxenda, a once-daily injection, set to end in Korea in late August next year, the market is shifting toward pills and longer-acting injections administered every two weeks or once a month.

A study recently presented at the European Association for the Study of Diabetes found that 194 patients who switched from injectable semaglutide or tirzepatide to a once-daily oral version of Wegovy lost an additional 4.1 percent of their body weight on average over three months.

“Technology is advancing so fast that it’s unclear whether obesity drugs in development today will still be competitive when they reach the market in a few years,” a Korean pharmaceutical industry source said.

Eppe’s pitch rests on three advantages: lower prices, a stable supply from domestic production and clinical data from Korean patients. Hanmi Pharmaceutical also claims that not many test patients experienced gastrointestinal side effects, including nausea and vomiting. But it lacks clinical trial data from direct comparisons with rival drugs.

“From a medical standpoint, preserving muscle and reducing the risk of cardiovascular and kidney disease matter, but consumers ultimately care most about how much weight they can lose,” said Prof. Oh.

“Eppe’s weight loss results are relatively modest, and Wegovy and Mounjaro could also [respond to competition by] cutting prices. That makes pricing crucial. If Eppe can prove that it causes fewer gastrointestinal side effects, that could also help set it apart.”

BY CHOI EUN-KYUNG [[email protected]]