New Delhi: Only around 250,000 of India’s estimated 250 million people living with obesity are currently taking GLP-1 medicines, putting treatment penetration at about 0.1 percent, Novo Nordisk India Managing Director Vikrant Shrotriya told ThePrint in an exclusive interview Tuesday.
GLP-1 medicines are a newer class of drugs that mimic a hormone involved in regulating blood sugar, appetite and food intake. They were initially developed for diabetes but are now also widely used to treat obesity.
Shrotriya’s comments come as India’s GLP-1 market enters a more competitive phase. Cheaper generic versions of semaglutide entered the market in March this year after Novo Nordisk’s patent protection ended in India. Semaglutide is the active ingredient in Novo Nordisk’s diabetes drug Ozempic and obesity drug Wegovy.
US-based pharma company Eli Lilly has, meanwhile, emerged as a major rival with tirzepatide-based Mounjaro. Tirzepatide has become the largest GLP-1 segment in India, with sales of around Rs 1,300 crore compared with about Rs 717 crore for semaglutide.
Shrotriya said Novo Nordisk’s Wegovy and Ozempic continued to grow despite the rapid expansion of tirzepatide and the entry of generic semaglutide. He said the company was looking at the market as a long-term effort to tackle India’s large obesity burden, rather than a short-term battle for market share.
“It’s a marathon…The race to tackle the disease burden is a very long-haul game,” he said.
The overall GLP-1 market bounced back in July after a slowdown in June, with Pharmarack data showing sales of Rs 2,215 crore in the 12 months to July, up 235 percent from the previous year.
Shrotriya said monthly fluctuations in sales reflect distribution patterns, but the broader trend is that more patients are accessing the drugs through doctors.
“This is just scratching the surface,” he said, adding that the market’s expansion would also be driven by a shift in how obesity is understood and treated.
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‘Obesity is much more than calories’
Until recently, obesity was largely viewed as a matter of eating less and exercising more, Shrotriya said. While some people manage to lose weight through sustained lifestyle changes, he said this approach has proved difficult for the majority.
GLP-1 medicines have changed that conversation by helping doctors and patients understand obesity as a biological and metabolic condition.
“It’s not just about calories. It is much more than the calories. It is a talk between the gut and the brain,” he said.
Doctors are now increasingly “medicalising” obesity, he said, with prescriptions specifically aimed at weight reduction rather than merely recording weight as an associated risk factor for diabetes, hypertension or heart disease. He said obesity can accelerate more than 200 diseases and act as a trigger for several conditions.
But Shrotriya said GLP-1 medicines should not be viewed as a quick fix. Whether patients need long-term treatment would depend on how their weight responds after stopping the drugs. Some may be able to maintain their weight with sustained lifestyle changes, while others may need treatment again if the weight returns.
“In obesity, it is a ping pong ball. You know, you reduce, it bounces back,” he said.
“There is nothing like.. if one is obese, and can have a rescue pill or an injection, and the obesity will reduce.. Unfortunately, that is not true,” he added.
Research is also exploring possible uses of GLP-1 medicines in conditions such as Alzheimer’s disease and alcohol addiction, but Shrotriya said these remain experimental and require clinical evidence.
He said that the bigger measure of success would be whether India can reverse its rising obesity trend.
“First time ever, I look forward to that success in India when we can bend the curve of obesity together,” he said.
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Generics, quality, prices and what comes next
The entry of generic semaglutide has also raised quality questions.
In July, Hyderabad-based Dr Reddy’s Laboratories said certain batches of its generic semaglutide were found to be out of specification because of an issue with the active pharmaceutical ingredient, delaying commercial supplies.
However, the company said there was no impact on patient safety.
“I can talk about our quality,” Shrotriya said, highlighting Novo Nordisk’s control over its recombinant-DNA-based molecule, pen, needle and assembly process.
On calls for stricter quality and manufacturing requirements for GLP-1 drugs, he said the decision should be left to regulators.
“I leave it to the regulators,” he said, adding that he had “full faith in the system”.
Novo Nordisk also does not intend to enter a price war, he said. Earlier price cuts were a response to the Indian market and aimed at expanding access.
“We are not in a price war, and neither were we in a price war,” he said.
He also strongly opposed GLP-1 medicines being sold without prescriptions through online platforms or local chemists.
“I strongly discourage… I think that is not right for society,” he said.
Beyond GLP-1s, Novo Nordisk is betting on its once-weekly basal insulin Awiqli, launched in India about a month ago.
Shrotriya said the company hopes it will bring more patients onto insulin, particularly those who have delayed treatment because of the burden of daily injections.
India has only around five to six million people on insulin, he said, while average HbA1c levels remain well above the commonly targeted 7 percent.
“There is a large scope to initiate insulin,” he said.
Novo Nordisk is also developing a new generation of medicines that could shape the next phase of the obesity and diabetes market.
Its pipeline includes cagrisema, amycretin and ziltivekimab, which are in phase 3 trials. Some candidates have already been submitted to regulators, while others are still being studied, Shrotriya said.
He said the company cannot predict which of them could become the next “blockbuster”, saying even the success of Ozempic had been difficult to foresee.
“We never thought that Ozempic will be the blockbuster. It became the blockbuster,” he said.
Emerging portfolio for rare diseases
Rare diseases are another area Novo Nordisk India is looking to expand into, with sickle cell disease and haemophilia among its focus areas.
Sickle cell disease is an inherited blood disorder in which red blood cells become abnormally shaped, reducing their ability to carry oxygen and potentially causing severe pain, anaemia and organ damage.
Shrotriya said Novo Nordisk is developing a treatment candidate with India’s disease burden in mind and is conducting trials in the country.
“For the very first time, a multinational is designing a product for India,” he said, referring to the company’s sickle cell programme.
Novo Nordisk is also working with state governments and has set up wellness centres in Rajasthan and Madhya Pradesh focused on awareness, screening and treatment.
Shrotriya said the company is partnering with governments towards India’s target of eliminating sickle cell disease by 2045.
In haemophilia, a genetic disorder that affects blood clotting. Novo has treatments targeting factors VII, VIII, IX and XIII, proteins in the blood that help it clot and stop bleeding. Its portfolio also includes Mim8, a newer non-factor treatment that works differently from conventional clotting-factor therapies.
(Edited by Sugita Katyal)
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