The race is on to make the first oral weight loss medicines, but smaller US pharmacies may have already got there – if they can persuade US regulators their products are legal
Would you be tempted to try a weight loss medicine if it came in the form of daily gummies instead of weekly injections?
One million people in the UK are thought to be using weight loss jabs. But this may be a small fraction of the number who end up using the drugs once they arrive in easier-to-take oral forms.
The medicines are being turned into a range of pills, gummies, melt-in-the-mouth strips and under-the-tongue drops.
Tablets of semaglutide (currently sold in injectable form as Wegovy for obesity and Ozempic for diabetes), made by the Danish firm Novo Nordisk, could reach the UK as early as next year.
Drug firms are also investigating if branded oral formulations may suit people better as a maintenance strategy after weight loss, said Professor Giles Yeo, an endocrinologist at the University of Cambridge. “I think it is going to be effective for people that don’t like needles. A lot of us now take a pill a day for something or other.”
“The more options we have the better,” said Professor Carel le Roux, an obesity specialist at Imperial College London. “The oral medications will bring other people into the system.”
In the meantime, smaller US firms have already developed more unusual oral formulations of semaglutide, designed to enhance its potency. It is unclear how well they work, and some obesity experts warn that selling the medicines as gummies and similar forms could encourage people to take the drugs for cosmetic purposes.
Promoting fullness
Weight loss drugs work by mimicking a hormone called GLP-1, which is released after eating. They slow digestion, make people feel full, and also boost insulin, involved in blood sugar control.
The GLP-1 mimics had been used for several years as a treatment for type 2 diabetes, but once found to cause weight loss, they were rebranded as obesity treatments.
The first with significant potency, Wegovy, arrived in the US four years ago and initially only small amounts trickled through to the UK via people who bought personal supplies while in America.
But Wegovy and a similar jab called Mounjaro are now sold through online pharmacies in the UK for as little as £100 to £125 a month.
In fact, it can now be cheaper to get the jabs in the UK than in America, because of higher US drug prices. Americans can pay the equivalent of £400 a month or more for the branded medicines.
The high US prices have fostered a controversial but currently legal market for cheaper versions of the drugs from online firms working with small suppliers called “compounding pharmacies”.
Such pharmacies arose to help customers who need different formulations of medicines. For instance, if someone can’t swallow tablets, a compounding pharmacist may create a liquid version by crushing up pills and adding them to a syrup.
A young woman in exercise gear runs up some stairs
People taking weight-loss medicines still need to exercise (Photo: Zorica Nastasic/Getty Images/E+)
How gummies work
Compounding pharmacies are also allowed to sell the same formulations as brand-name medicines if there is a shortage of the branded version – as was the case for Wegovy and Mounjaro for a time.
Such firms have also driven development of the novel oral formulations like gummies. A standard tablet version of semaglutide, called Rybelsus, is sold by Novo Nordisk for type 2 diabetes. But as a large protein-like molecule, it is absorbed poorly in the stomach, and needs a high amount of drug in the tablets compared with Wegovy injections.
Novo Nordisk has therefore been developing a higher-dose version of the tablet, which gives similar weight loss to the injections, a trial showed in 2023. “There are people that are more averse to using needles as a therapy so there’s definitely a unique market,” said analyst Simon Wells of health data firm Airfinity.
But some people might find it harder to remember to take a pill every day, he added. “If patients only [take] it five out of seven days a week, how much benefit are they going to be seeing versus the once-weekly injectable, which maybe they actually do stick to.”
Airfinity expects the Novo Nordisk weight loss tablets to arrive next year. In the meantime, the compounding pharmacies are already selling their oral versions.
One US firm, for instance, sells tablets of semaglutide and tirzepatide designed to be sucked until they dissolve, as well as drops of semaglutide in a liquid, for under the tongue. It said the formulations “allow for patients with an aversion to, or fear of, needles and syringes to take control of their health” and that the oral forms can be more convenient to take and don’t need refrigeration.
Another firm sells semaglutide gummies, while one company sells semaglutide lozenges.
Within the next few years, there could be other branded oral weight loss drugs available, including a melt-on-the-tongue version of semaglutide, from Canadian firm BioNxt solutions, and ordinary tablets of a drug called orforglipron, which can be absorbed in the stomach.
The current gummy-type products from compounding pharmacies should be treated with caution, said Professor Yeo.
Professor Daniel Drucker, an endocrinologist at the University of Toronto, who helped discover the GLP-1 mimics, said the orally absorbed versions could work in theory, but no studies have yet been done to see how they compare with those of injections. “It’s an interesting concept. But we have to see the data,” he said.
But Sarah Le Brocq, co-founder of patient support group All About Obesity, said: “Creating gummies is taking away the authoritativeness of this being a medication for a chronic condition. The fact we’re going down this route fills me with dread.”
Grey market
Such a “grey market” for weight loss medicines is inevitable as their price is so high in the US, said Nicholas Reville, director of a US addiction charity called CASPR, which is interested in the drugs as they also seem to help people reduce drug and alcohol use. “If we have a treatment that we know reduces mortality for people who have obesity, and you’re not providing that affordably, they’re going to find other ways of getting it,” said Reville.
But the future of these medicines is uncertain, as US medicines regulator the Food and Drug Administration (FDA) has recently declared that the shortage of the branded weight loss injections is over.
A court ruling means that the compounding pharmacies should stop selling their versions of the drugs from May at the latest. The FDA is likely to send letters to the pharmacies instructing them to stop, said Lowell Schiller, a legal expert at the Schaeffer Institute.
Novo Nordisk and Eli Lilly, the manufacturer of Mounjaro, have said they will take legal actions against the compounding pharmacies, and called their non-branded versions “knockoffs”.
A spokesperson for Novo Nordisk said: “Unapproved fake or illegitimate knockoffs expose patients to serious safety and efficacy risks. These unapproved drugs undermine the FDA drug approval system.”
Eli Lilly said: “No oral tirzepatide product has even been studied in humans, meaning these sellers are experimenting on unsuspecting patients. We will work with regulators to stop anyone who continues selling knockoff oral tirzepatide.
A spokesperson for the UK’s Medicines and Healthcare products Regulatory Agency said: “Weight loss medicines containing semaglutide are prescription-only and should only be taken following a consultation with a qualified healthcare professional. Sourcing prescription-only medicines in any other way significantly increases the chance of taking something which is not licensed for use in the UK.”