Mounjaro, Wegovy and the Indian Stock Market

A few months ago Wegovy (semaglutide) and Mounjaro (tirzepatide) were launched in India. These GLP-1 drugs, also known as glucagon-like peptide-1 receptor agonists, are a class of medications primarily used to treat type 2 diabetes and obesity. Media reports suggest that both these drugs are seeing rapid uptake and doctors say the increased awareness as well as social media conversations about both these drugs is nudging many young adults in their thirties and early forties to seek them. With over 200 million diabetes patients and one of the fastest growing obesity patient cohorts, the drug launches couldn’t have been timelier. They can help in significantly controlling the disease burden for India.

However, there are several second order effects of GLP-1 drugs that go far beyond alleviating diabetes and obesity but with serious ramifications which, I believe, are important for this community to consider.

In the west, the rise of GLP-1 drugs is rippling far beyond the pharmaceutical sector. Their widespread use is reshaping consumer behavior, spending patterns triggering significant implications across multiple industries and as a result impacting stock price.

For the FMCG sector, particularly food & beverage, liquor and fast-food companies, the impact is largely negative. Studies have shown that GLP-1 users consume 15–40% fewer calories and show reduced cravings for high-calorie, sweet, salty, fatty foods. Users have also reported significantly reduced cravings for alcohol, impacting sales for beer, wine, and spirits. This led to households with a GLP-1 user spending about 6% less on groceries, with high-income households cutting back by >9%!

Fashion retailers, however, are seeing the opposite effect. As consumers shed their weight, they are revamping their wardrobes, leading to increased apparel sales and an increased demand for smaller sizes. This trend is particularly pronounced in luxury and mainstream fashion.

Over the long term, better health of the patients also leads to reduced diabetes/obesity related complications and therefore reduced hospital visits which in turn leads to lower insurance payouts.

Presently, the high cost of Mounjaro and Wegovy in India limit its access. However, there are several Indian pharma companies that are poised to launch low-cost generics in the next 18-24 months. As access improves the aforementioned trends will become visible and begin impacting various sectors. The present valuation of FMCG, liquor, fast food and the associated companies in the value chain is premised on the assumption of high growth which in turn is premised on the low penetration of these goods in India. None of the broking houses in India account for the “GLP-1 Risk” in their valuation models of these stocks while analysts in developed markets have begun actively modelling for “GLP-1 impact”.

In conclusion, there are many more GLP-1 drugs in the pipeline and in time these drugs could become the mainstay of how chronic diseases are treated. India now has the tools to tackle the diabetes and obesity epidemic that it has been facing for a long time.
Therefore, it’s time to bet on an India that is fitter and healthier.

Disc: This post was created as a “thought starter”. Views are personal

Some References:

  1. Obesity GLP-1 Drug Trends | Off-label GLP-1 Drug Use
  2. How Weight Loss Drugs Are Shaping the Luxury Fashion Landscape
  3. Non-Diabetic Use Of GLP-1 Drugs Like Ozempic For Weight Loss Affecting Retail Sizing Curves
  4. Use of GLP - 1 drugs by dieters may impact snack brands | EY - US
  5. GLP-1: Transforming weight loss and the food industry | Roland Berger
  6. The Impact of GLP-1 Drugs on Food and Beverage Demand - Euromonitor.com
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if possiable please let us know who are all the first mover advantage on this drug and entire value chain


Despite the higher cost, both are witnessing good traction in recent months ..

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Shaily Engineering Plastics is a direct beneficiary of the incoming wave of Diabetes / Weight loss drugs as they transit to the generic category in the coming months

They manufacture the GLP1 pens used to administer these drugs .

The planned CAPEX is INR100 Crs in FY26 to increase medical pen (injector) capacity from ~45 million to ~85 million devices due to the forecasted demand of Ozempic and other weight loss drugs .

The 2 downsides -

1.) These drugs don’t become as widely consumed in India as expected

2.) The rise of oral dosage of the same drugs becomes more popular but having said that the efficacy rate and effectiveness of the injectables will always be higher and show faster results

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Thanks for initiating this thread. I’m sharing a research I did on the GLP-1 drug value chain and how some potential Indian companies may benefit. Though this might add to the discussion.
Value Chain Overview
The GLP-1 value chain consists of four key segments: APIs, devices, fill-finish, and innovator/generic filers. Each stage of manufacturing faces unique supply constraints, creating bottlenecks as demand
continues to surge.

  1. API
  2. Injectable devices
  3. Fill and finish
  4. Innovator or generics

Active Pharmaceutical Ingredients (APIs)
APIs are the core substances in any medicine that produce the intended health benefits. In the case of GLP-1 drugs, they include molecules like Liraglutide, Semaglutide, and Tirzepatide. These molecules are peptides or short chains of amino acids that form the building blocks of proteins. Some peptides, like Semaglutide, are produced using living cells, while others (e.g., Tirzepatide) can be made through chemical synthesis. Novo Nordisk manufactures its APIs in-house, whereas Eli Lilly employs a mix of in-house production and contract manufacturing (CDMO) partnerships. Manufacturing peptide APIs is complex. It requires precise assembly of amino acids, specialized equipment, and stringent conditions to preserve the molecules’ structure and effectiveness. Therefore, only a few global players can develop peptide APIs at scale. This has led to demand outstripping supply, prompting major industry players like Bachem and WuXi to announce large capital expenditures aimed at ramping up GLP-1 API production.

Injectable Devices
GLP-1s except orals are administered via injectables, primarily in two forms: auto-injectors and pen injectors. An auto-injector (single-use) delivers medication with a single push, while a pen injector (multi-use) allows patients to control the dose themselves, ideal for frequent use. In practice, a patient might need four auto-injectors per month or one pen injector, depending on the brand and prescription. (Ozempic is sold in multi dose pen and others like wegovy, mounjaro and zepbound are single use pens)

Device manufacturing for GLP-1 therapies is inherently complex, demanding stringent regulatory compliance. As drug-device combinations, GLP-1 products require approval not only for the drug but also for the delivery device, adding another layer of complexity. The market is further safeguarded by a dense patent landscape surrounding these devices. Innovators have strategically extended market exclusivity by filing numerous patents focused on delivery mechanisms. In fact, a study revealed that 63% of all patents for insulin-related drug-device combinations pertain to delivery devices rather than the drug itself. The high patent density makes it extremely difficult for new players to develop novel designs without infringing existing patents. Hence, only a handful of global players such as Ypsomed, SHL, Becton Dickinson, Owen Mumford, Philips Medisize and West Pharma manufacture these devices. Although the Intellectual Property can be owned by either the drug innovator or a contract manufacturer, the actual production is handled by the latter. Owing to the limited number of players in this segment and growing demand for injectable devices across multiple therapies the supply has been constrained. As a result, manufacturers are committing to large capital expenditure programs.

Fill and Finish
APIs and delivery devices are often manufactured at separate facilities. Once ready, the API is transported to a fill-finish facility, where it is filled into containers like pre-filled syringes, vials or cartridges and then assembled with the delivery device. This step ensures the product is ready for use and meets strict safety and quality standards. This step can be done inhouse or outsourced to CMOs. Surging demand for injectable devices which is led by GLP-1 therapies has created a severe shortage of fill-finish capacity. Novo’s $16.5 billion acquisition of Catalent, a large CMO, underscores the market’s urgency and has drawn scrutiny from regulators and competitors like Eli Lilly, as it could further tighten supply. The industry’s future also depends on the type of injector used. Auto-injectors (e.g. Wegovy, Mounjaro, Zepbound) are mostly single-use and require multiple devices per month, while pen injectors (e.g., Ozempic) are multi-use, needing fewer devices overall. As auto-injectors multiply, fill-finish demands will keep rising. To ease supply pressure, some companies plan to shift more volume to multi-use pens, Eli Lilly, for example, aims to transition Mounjaro to its multi-use KwikPen.

Generics
For many people the cost of GLP-1 medications is a major concern and is a barrier to access it. Low-cost generics is a way to break that barrier. Generics are low-cost drugs that is equivalent to a brand name product made after the expiry of the patents, and has the same dosage form, safety, efficacy and performance.

In 2024, the first two generic GLP-1s were approved: exenatide (Byetta) and liraglutide (Victoza). And we could see additional Victoza generics in 2025. Teva Pharmaceuticals also launched a generic of Victoza (liraglutide), the first generic GLP-1 drug in US. The patent for the latest GLP-1 Semaglutide is expiring in March 2026 in India and RoW and extending till 2032 in USA, which would open the opportunities for a lot of generic producing companies to enter this market.

GLP-1 opportunities in India

API’s
Divi’s Laboratories appears to lead the race, thanks to optimism around its Custom Synthesis (CSM) business. It is reportedly in talks with an innovator (likely Eli Lilly) to develop a key building block for peptide-based APIs. Divi’s is also expected to supply APIs to generic players.

Neuland Laboratories is in active discussions to provide APIs for future generic launches. Meanwhile, Piramal Pharma has 14 peptide APIs in its portfolio, with 12 more under development, including Liraglutide and Semaglutide. Shilpa Medicare is also focusing on GLP-1 products with DMF for liraglutide and Semaglutide formulation batches ready. Eris lifesciences is working on the GLP-1 agonist formulation for the Indian market.

Devices
Shaily Engineering stands out as India’s only major listed player in GLP-1 device manufacturing. The company is pivoting from a crowded, low-ROCE moulding business to a high-entry-barrier medical devices model. Shaily is the first to develop plastic insulin pens and is now tapping into the GLP-1 generics opportunity with its own IP platforms. According to the management, 70% of generic Semaglutide fillers rely on Shaily’s device, as it is the only one globally that closely matches the innovator’s reference device without infringing on patents. The decision to expand capacity from 40 million to 100 million devices covering both diabetes and weight-loss treatments and it’s recent development of a new device for which they are targeting global large pharma companies show their part in this market.

Fill Finish

One Source operates as a fully integrated fill-finish CDMO. Its expertise spans pre-filled syringes, cartridges, and vials, with a portfolio of nine molecules that includes GLP-1s. The company has already secured commercial supply agreements worth around $800 million from FY24 to FY32. Considering strong demand, it plans to scale capacity from 40 million to 150 million units, with a portion of the expansion cost funded by customers.

Generics
There is going to be a fierce competition for the GLP-1 gererics. Near-term opportunities exist in Liraglutide, where Biocon is the only Indian firm with EU approval so far. However, the real game changer will be Semaglutide, with its high demand and patent expirations beginning in 2026 for RoW markets and extending to 2032 in the US.

For Semaglutide, Natco holds a first-to-file (FTF) approval with Viatris for the U.S. market, while other Indian companies like Dr. Reddy’s, Sun Pharma, Lupin, Cipla, Aurobindo, and Zydus, have submitted their ANDA filings. Sunpharma is aiming to launch its experimental anti-obesity and type 2 diabetes drug in the next four to five years called Utreglutide for which it expects phase-2 clinical trials.

Happy to hear any thoughts!

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And so, it begins…
Food Chained: How weight-loss drugs are changing India’s eating habits and forcing restaurants to take note - The Economic Times

I spent the past weeks researching GLP-1 drugs and companies that might benefit from these drugs, what follows is my notes on the topic -

disclaimer - i am not a doctor; most of my knowledge is from reading company fillings / clinical trials and scientific papers, i am long in some of the companies mentioned in this thread.

notes:

In the history of medicine, few drugs tower above all others, drugs which helped patients far beyond doctors’ initial expectations and continue to benefit millions of people every day. We have such a drug for obesity & diabetes - GLP-1 receptor agonists. Glucagon-like peptide 1 receptor agonists known as GLP-1 such as semaglutide and tirzepatide are a class of medications developed to treat diabetes and obesity. GLP-1 RAs have revolutionized the approach to obesity treatment, becoming the most effective non-surgical pharmacological intervention available. Current GLP-1 RAs such as once-weekly subcutaneous semaglutide help in mean body weight reduction of approx 15% in individuals with obesity; Dual glucose-dependent insulinotropic polypeptide (GIP) and GLP-1 receptor agonists, like once-weekly tirzepatide resulted in the mean body weight changes of -17.5%.

GLP-1 is a USD150–175bn global market opportunity over the coming decade. In the United States alone, the obesity epidemic affects over 100 million adults and almost 15 million children, representing 41.9% of the adult population and 19.7% of the child population, which has quadrupled over the last 30 years. Obesity is defined as having a BMI over 30.0 kg/m² and is linked to many significant chronic diseases, including diabetes, heart disease, and some types of cancer. This epidemic contributes to $173 billion in annual healthcare costs. The global market for obesity drugs could increase by more than 15-fold by 2030 as their use expands beyond weight loss to treat a range of diseases.

Two companies dominate the GLP-1 landscape: Novo Nordisk and Eli Lilly. Novo Nordisk’s portfolio includes liraglutide (Victoza® for diabetes, Saxenda® for obesity) and semaglutide (Ozempic® for diabetes, Wegovy® for obesity, and Rybelsus® as an oral tablet) – all GLP-1 analogues. Eli Lilly’s offerings include dulaglutide (Trulicity®, a once-weekly GLP-1 RA for diabetes) and tirzepatide (Mounjaro® for diabetes and Zepbound® for obesity, a dual GIP/GLP-1 agonist).

How can a weight loss drug do everything?

GLP-1 is a hormone secreted by special gut cells in your lower intestine whenever you eat carbohydrates, fats or proteins. The primary physiological role of GLP-1 is to connect nutrient consumption with glucose metabolism, acting as a crucial signal to the body that food has been consumed and metabolic adjustments are required. In its natural form, GLP-1 rises quickly after a meal, then vanishes within minutes, so it never makes it far enough to have a sustained therapeutic effect.

Once released, GLP-1 flips three key switches. In the brain, it triggers the feeling of fullness so you naturally eat less. In the stomach, it slows down how fast food empties into your intestines, extending that satisfied-after-a-big-meal feeling. And it triggers the pancreas to release more insulin lowering blood sugar and less glucagon raising blood sugar.

Drugs like semaglutide work because they combine a fatty-acid “tail” attached to the GLP-1 “head”. The head binds to, and activates, the GLP-1 receptors. The tail protects the head, because it is tough and sticky, slowing down the rate at which the body breaks it down.

The ability of GLP-1 RAs to do everything largely stems from the activation of GLP-1 receptors across numerous organs and tissues in the body, well beyond the pancreas. When the supercharged GLP-1 RAs enter the bloodstream and persist due to their prolonged half-life, they can activate these receptors in various locations, leading to a cascade of beneficial effects.

Currently Approved GLP-1 Drugs

There are six FDA‑approved chronic weight‑loss drugs: orlistat, phentermine–topiramate, naltrexone–bupropion, liraglutide 3.0 mg (Saxenda), semaglutide 2.4 mg (Wegovy), and tirzepatide (Zepbound). Two are GLP‑1–based (liraglutide, semaglutide). Tirzepatide is a dual GIP/GLP‑1 agonist with its own obesity label. Saxenda, Wegovy, and Zepbound are subcutaneous injections; the others are oral.

Exenatide (Byetta; exenatide ER/Bydureon)

Exenatide, the first GLP‑1 RA (2005), is a synthetic exendin‑4 that resists DPP‑4. Byetta 5–10 µg BID lowered A1c with modest weight loss and inconvenient dosing. Bydureon 2 mg weekly improved adherence, but EXSCEL showed MACE noninferiority vs placebo. AstraZeneca discontinued Byetta and Bydureon BCise in the U.S. in Oct 2024.

Liraglutide (Victoza; Saxenda)- Once‑daily analog with proven CV benefit. LEADER: 3‑point MACE HR 0.87 with significant reductions in CV and all‑cause mortality. Saxenda 3.0 mg daily produces clinically meaningful weight loss (SCALE). Victoza generics entered 2024.

Dulaglutide (Trulicity)- Once‑weekly 0.75–4.5 mg with broad primary‑care reach. REWIND showed MACE reduction (HR 0.88) in a population with mostly multiple risk factors and ~31% established CVD; the U.S. label includes reduction of MACE in T2D with CVD or risk factors. Data support renal benefit signals (slower eGFR decline, fewer new macroalbuminuria events).

Semaglutide (Ozempic; Rybelsus; Wegovy) - Single‑agent backbone across diabetes, obesity, and CV risk reduction. Ozempic weekly for T2D; Rybelsus oral for T2D; Wegovy 2.4 mg weekly for obesity and for reducing CV risk in adults with established CVD and overweight/obesity (FDA label March 2024, supported by SELECT: 20% MACE reduction, HR 0.80). SUSTAIN‑6 showed MACE reduction (HR 0.74) but no significant mortality reduction; PIONEER‑6 established CV safety for oral dosing. STEP‑1 showed ~15% mean weight loss at 68 weeks.

Tirzepatide (Mounjaro; Zepbound) - Dual GIP/GLP‑1 agonist setting the efficacy bar. In T2D, SURPASS trials beat semaglutide 1 mg on A1c and weight (e.g., SURPASS‑2). In obesity, SURMOUNT‑1 showed ~15–21% mean weight loss at 72 weeks and head‑to‑head data show greater loss than semaglutide in non‑diabetic obesity. U.S. approvals: T2D (Mounjaro, 2022), obesity (Zepbound, 2023), and obstructive sleep apnea with obesity (Zepbound, 2024)

Ongoing Innovations in GLP-1s Landscape

The obesity pipeline from phase 1 to market now includes 173 drugs, with GLP-1 and combination therapies accounting for majority of trials. We are seeing innovations happening in the oral GLP-1s, dual GIP/GLP‑1 and GLP‑1/glucagon co‑agonists, triple GIP/GLP‑1/glucagon agonists, and amylin co‑agonists.

Oral Formulations

oral GLP-1 are 1) much easier to manufacture at scale compared to the current injectable GLP-1 drugs, 2) much simpler to distribute globally, given no need for cold-chain storage, 3) more attractive for needle-phobic patients who avoid the injectable GLP-1 drugs currently available, and 4) better suited to long-term maintenance therapy, given what we expect will be lower pricing (and lower costs) for orals compared to injectable GLP-1 drugs.

Drug Company Description Current Phase Mechanism
SMALL MOLECULES
Orforglipron Eli Lilly First oral small molecule GLP-1 receptor agonist with no food/water restrictions; achieved 27.3 lbs weight loss in Phase 3 Phase 3 GLP-1 RA
Aleniglipron (GSBR-1290) Structure Therapeutics Small-molecule GLP-1 agonist; Phase 2b ACCESS studies fully enrolled, results by year-end 2025 Phase 2b GLP-1 RA
AZD5004/ECC5004 AstraZeneca/Eccogene Oral small molecule showing 5.8% weight loss in 4 weeks; currently in global Phase 2b VISTA and SOLSTICE trials Phase 2b GLP-1 RA
CT-996 Roche/Genentech Once-daily oral small molecule; 6.1% placebo-adjusted weight loss in 4 weeks; advancing to Phase 2 Phase 2 GLP-1RA (biased)
PEPTIDES
Oral Semaglutide (Rybelsus) Novo Nordisk First and only FDA-approved oral GLP-1 (since 2019); 25mg version pending approval for weight management Approved/Ph3 GLP-1 RA
HRS-953 Hengrui Pharma Oral GLP-1 receptor agonist in late-stage development for obesity and type 2 diabetes Phase 3 GLP-1 RA
DUAL AGONISTS
Amycretin Novo Nordisk Dual GLP-1/amylin receptor agonist; 13.1% weight loss at 12 weeks; Phase 3 starts Q1 2026 Phase 3 GLP-1/Amylin
VK2735 Viking Therapeutics Dual GLP-1/GIP agonist; oral Phase 2 fully enrolled, results expected H2 2025 Phase 2 GLP-1/GIP

Eli Lilly - Orforglipron (oral, small‑molecule GLP‑1 RA)

Orforglipron is an oral, non-peptide, small-molecule GLP-1 receptor agonist developed by Eli Lilly. The drug is taken once daily by mouth without food or water restrictions and has an elimination half-life of 29 to 49 hours. Eli Lilly reported phase 3 clinical data for its oral GLP-1 drug orforglipron (orfor) on 7 August 2025. That data was presented in the ATTAIN-1 trial, and measured weight loss in an obese patient population. While the ATTAIN-1 trial successfully met its predetermined weight loss endpoints versus placebo, the weight loss percentage realized in the highest dose fell modestly short of investor expectations, with average weight loss of 12.4% versus placebo at 0.9%. most common side effect were mild to moderate gastrointestinal related, treatment discontinuations due to adverse effects across the three doses were 5.1% , 7.7% and 10.3% respectively versus 2.6% for placebo.

Orforglipron’s weight loss is disappointing and falls short of street expectations. Discontinuation rates however are better than expected. Orforg is likely still a viable option for needle-phobic obese patients without food effects and greater manufacturing scalability. Though weight loss data may be a harder sales pitch relative to generic semaglutide.

Novo Nordisk - Amycretin (2x50mg daily oral)

Amycretin is a novel, single-molecule co-agonist that targets two different receptors: the GLP-1 receptor and the amylin receptor. Amylin is another natural hormone that is co-secreted with insulin from the pancreas after meals and plays a role in glucose regulation and appetite control. By activating both of these pathways, Amycretin is designed to have a more potent and potentially complementary effect on weight loss compared to a GLP-1 agonist alone. Novo Nordisk recently published first-in-human data for Amycretin and is advancing both oral and subcutaneous formulations of Amycretin into Phase 3 development for weight management. Oral amycretin Phase 1 trial - The trial evaluated the single-ascending dose and multiple ascending doses for oral amycretin, up to 2x 50 mg, in 144 people with overweight or obesity, with a total treatment duration of up to 12 weeks.

After 12 weeks of treatment with amycretin up to 50 mg and up to 2x 50 mg, participants achieved a mean change in body weight of -10.4% and -13.1% respectively, compared to -1.2% with placebo. GI-related side effects were the most common, accounting for approximately 49% of all adverse events.

Viking Therapeutics - VK2735 (oral, dual GLP‑1/GIP agonist)

Viking Therapeutics is actively developing VK2735, a dual agonist of glucagon-like peptide-1 (GLP-1) and glucose-dependent insulinotropic polypeptide (GIP) receptors, with both subcutaneous and oral formulations in its pipeline.
Viking’s tablet formulation of VK2735 completed a 28‑day multiple‑ascending‑dose Phase 1 trial in adults with obesity (BMI ≥ 30 kg/m²). Doses from 2.5 mg to 100 mg were titrated weekly. The 100 mg cohort achieved an 8.2% mean weight loss from baseline (‑6.8% placebo‑adjusted) in just four weeks, with the trajectory still trending downward at Day 28 and durability to Day 57 (‑8.3% from baseline four weeks off-drug).

VK2735 delivers the steepest early weight loss slope among oral agents (‑8% in 4 weeks). If the curve remains linear, it could meet or exceed Amycretin’s 12 week benchmark, while its mild GI profile and balanced discontinuation rates provide a tolerability edge over Orforglipron.

Novel Mechanisms

Novo Nordisk - CagriSema (once‑weekly, subcutaneous)

CagriSema is a fixed-dose combination of a long-acting amylin analogue, cagrilintide 2.4 mg and semaglutide 2.4 mg. This combination is designed to provide synergistic effects on weight loss and glycemic control by targeting both amylin and GLP-1 receptors.

REDEFINE is a phase 3 clinical development program with once-weekly subcutaneous CagriSema in obesity. REDEFINE 1 and REDEFINE 2 have enrolled approximately 4,600 adults with overweight or obesity. REDEFINE 1 was a 68-week, double-blind, placebo- and active-controlled efficacy and safety phase 3 trial of once-weekly CagriSema, cagrilintide 2.4 mg and semaglutide 2.4 mg versus placebo in 3,417 adults with obesity or overweight with one or more comorbidities and without type 2 diabetes. REDEFINE 2 was a double-blind, randomized, placebo-controlled 68-week efficacy and safety phase 3 trial of once-weekly CagriSema versus placebo in 1,206 adults with type 2 diabetes and either obesity or overweight.

Eli lilly - Retatrutide (Once weekly, subcutaneous)

Retatrutide is a novel, once-weekly injectable triple agonist that targets the glucose-dependent insulinotropic polypeptide (GIP), glucagon-like peptide 1 (GLP-1), and glucagon receptors. Most weight loss occurred within the first 24 weeks, suggesting patients don’t need to wait a year to see clear results. For weight reduction, 92% of participants on 4 mg, 100% on 8 mg, and 100% on 12 mg achieved a 5% or more reduction at 48 weeks.

There are some interesting developments from China; the table below summarizes some interesting ones -

Developments in Indian GLP-1 market

Sun Pharma - Utreglutide (GL0034) (injectable, GLP-1 RA)

Utreglutide is a novel, long-acting GLP-1 receptor agonist being developed by Sun Pharma. It is a once-weekly subcutaneous injection for the treatment of obesity and other metabolic diseases. Healthy, obese male participants (n=24; Age 18-40; BMI ≥ 28 kg/m²) were enrolled into a fixed-dose Cohort 1 (4 x 680 µg) or an increasing-dose Cohort 2 (680/900/1520/2000 µg) and assigned to treatment groups in a 3:1 ratio, receiving 4 weekly doses of either GL0034 or a placebo


Understanding Value Chain

Two companies dominate the GLP-1 landscape: Novo Nordisk and Eli Lilly. Novo Nordisk’s portfolio includes liraglutide (Victoza® for diabetes, Saxenda® for obesity) and semaglutide (Ozempic® for diabetes, Wegovy® for obesity, and Rybelsus® as an oral tablet) – all GLP-1 analogues. Eli Lilly’s offerings include dulaglutide (Trulicity®, a once-weekly GLP-1 RA for diabetes) and tirzepatide (Mounjaro® for diabetes and Zepbound® for obesity, a dual GIP/GLP-1 agonist).

Methods of GLP-1 production

Solid Phase Peptide Synthesis (SPPS) – Eli Lilly produces its peptide APIs, like tirzepatide, using hybrid chemical synthesis platform. This method first creates smaller peptide fragments through the more controlled Solid-Phase Peptide Synthesis (SPPS). These highly pure, pre-assembled fragments are then joined together in a solution, a process known as Liquid-Phase Peptide Synthesis (LPPS), often utilizing continuous manufacturing technology. The key advantage of this method is that peptide synthesis can be segregated and different partners can produce parts of the final peptide drug substance for better utilization of the supply chain. This method is chemically intensive, requiring significant volumes of solvents and reagents which makes it costly.

Fermentation based synthesis – Novo Nordisk’s GLP-1 products are mainly produced through fermentation-based synthesis. It is relatively lower in cost compared to SPPS but difficult to outsource manufacturing. Novo Nordisk maintains tight in-house control over this entire, complex value chain.

Novo Nordisk leverages its deep expertise in fermentation-based API production, manufactures its GLP-1 APIs almost entirely in-house. In contrast, Eli Lilly utilizes a more outsourced manufacturing model for its chemically synthesized APIs. It relies on a network of CDMOs like WuXi AppTec & PolyPeptide Group among many other players. Eli lilly is building in house capacities as well as taking steps to diversify its Tirzepatide API supplies which are heavily dependent on China currently to European CDMOs & Divi’s in India.

fill finish

Fill–Finish refers to the final step of the manufacturing process that entails sterilization and standardization of medical containers and addition of drugs to the containers before sealing them. Both LLY and NVO were capacity-constrained, which limited the volume of sellable GLP-1 doses and caused shortages and are undergoing massive capex plans to expand capacity, including fill and finish pen device capacity, which represents the most significant bottleneck in the supply chain.

Novo Nordisk is investing $4.1 billion in a new 1.4-million-square-foot facility in Clayton, North Carolina, dedicated to filling injection pens for Ozempic and Wegovy. This massive fill-finish plant—with completion phased between 2027 and 2029—will match the combined floor space of Novo’s three existing U.S. sites. The company is also ramping in-house pen filling in Europe. Additionally, parent company Novo Holdings completed its $16.5 billion acquisition of CDMO Catalent in December 2024, immediately selling three strategic fill-finish sites (Anagni, Italy; Bloomington, Indiana; Brussels, Belgium) to Novo Nordisk for $11 billion. These sites will begin contributing to GLP-1 pen capacity from 2026 onward.

Eli Lilly has raised its Lebanon, Indiana investment to $9 billion (up from an initial $3.7 billion) to scale tirzepatide API production, with operations starting late 2026 and full ramp by 2028. In April 2024, Lilly acquired Nexus Pharmaceuticals’ Pleasant Prairie, Wisconsin injectable facility and is investing an additional $3 billion to expand it, with production expected to begin by 2027. Lilly has also partnered with contract manufacturers—including Resilience in the U.S. and BSP Pharmaceuticals in Italy—to add pen-filling and finishing capacity for Mounjaro and Zepbound.

Onesource speciality

OneSource Specialty Pharma is an India-based CDMO spanning biologics, complex injectables, soft-gel capsules, and drug-device combos. Five USFDA-audited Bengaluru plants can output over 100 m sterile doses, 2.4 bn capsules, and assemble autoinjectors and pens. The company is investing $100 million to expand production fivefold (increasing cartridge filling from ~40 million to 200+ million doses annually) to support day-one generic launches post-2026. Management expects GLP-1 generics to contribute over 10% of revenue in the first full year of launch and is targeting a 15–20% share of the global generic GLP-1 market by FY2028.

gland pharma

Gland Pharma makes sterile injectables for global markets with USFDA and EMA cleared sites in India and Europe. It sells via B2B development and CDMO work and via own-file launches, and it added EU capacity through the Cenexi deal. Formats include vials, prefilled syringes, cartridges, bags, and lyophilized drugs across oncology, anti-infectives, ophthalmics, and hormones. It has entered GLP-1 with a liraglutide launch and has two GLP-1 supply contracts. Cartridge output is rising from 40 million units by adding 100 million more by CY2026, with new lines for pens and cartridges. It targets GLP-1 fill-finish in cartridges and pens for partners in regulated markets.

Autoinjectors & Drug Devices

Autoinjectors deliver pre-measured doses through spring-loaded needles that activate with a button press, eliminating manual injection steps. These devices reduce dosing errors and improve compliance for weekly GLP-1 therapy. With the patent expiry of semaglutide in emerging markets; GLP-1 volumes will see substantial growth which will drive massive demand for pen and autoinjectors.

shaily engineering

Shaily Engineering Plastics is a leading Indian manufacturer of value-added, precision-molded plastic products, supplying global majors across healthcare, consumer, and industrial sectors, with over 75% of FY25 revenues from exports and long-standing relationships with clients like Sanofi, Aurobindo, IKEA, and GE Appliances. Shaily has invested heavily in its healthcare vertical, now comprising advanced drug delivery and injectable device platforms. The company is rapidly scaling as a contract manufacturer for GLP-1 therapies, including commercial launches of pen injectors for semaglutide and upcoming supplies for tirzepatide and dulaglutide devices, supported by seven pen platforms developed in-house and through its UK subsidiary. Shaily has signed eight contracts for pen and auto-injector platforms—particularly for semaglutide and related drugs— with first commercial supplies in FY26, and is expanding pen manufacturing capacity from ~40 million to 80–90 million pens a year, targeting both generic and innovator pharma in regulated and growth markets such as Canada and Brazil.

second order effects from GLP-1 drugs

Category Second Order Effect
Food & Beverage Consumption Reduction in overall caloric intake and grocery spending; decline in demand for high-calorie foods, soft drinks, juice and alcohol; greater interest in nutrient-dense, smaller portions and functional foods
High-Protein & Functional Foods Shift towards high‑protein bars, shakes and nutritional supplements; growth of meal replacement drinks, macronutrient blends, and GLP-1 nutrition products
Frozen Foods & Grocery GLP‑1 users purchase more frozen fruits and vegetables and seek high‑protein frozen meals; interest in portion-controlled and healthy frozen foods
Apparel & Fashion Shifts in clothing sizes: more demand for smaller sizes, activewear and athleisure; potential decline in plus-size and big & tall lines; retailers must adjust inventory and size curves
Fitness & Exercise Rising demand for resistance training, gym memberships, and digital fitness programs tailored for GLP‑1 users; gyms and wellness platforms offering programs to prevent muscle loss
Aesthetics & Skin tightening Rapid weight loss causes skin laxity (“Ozempic face”), loss of facial volume and sagging skin; increased demand for fillers, Botox, radiofrequency microneedling, high‑intensity focused ultrasound (HIFU), fractional lasers, body contouring and hair restoration treatments
Sleep Apnea & Medical Devices Although GLP‑1-induced weight loss reduces apnea severity, many patients still require CPAP machines; GLP‑1 users are more likely to adhere to therapy; obesity is not the sole cause of sleep apnea
Bariatric Surgery & MedTech GLP‑1 drugs reduce the need for bariatric surgery, leading to lower procedure volumes and impacting companies providing surgical instruments and hospitals
Mental Health & Psychosocial Effects GLP‑1 drugs quiet “food noise” and improve self-efficacy but may trigger mood changes, depression, anxiety, or altered pleasure responses; weight loss can exacerbate body image concerns and disordered eating; half of users discontinue due to side effects
Travel & Leisure High cost of GLP‑1 drugs may reduce discretionary spending on travel and entertainment initially, but improved self-confidence could later increase demand for active vacations and wellness tourism
Dialysis & Renal Care Improved glycemic control from GLP-1 slows progression to end-stage renal disease, moderating dialysis patient growth
Retail Pharmacy & Tele-health Spike in direct-to-consumer demand for GLP-1 prescriptions and refill logistics

Indian Obesity Landspace & Opportunity

Obesity rates in India are rising with obese/overweight adult population potentially growing from 180mn in 2025 to 450mn in 2050. Obesity rates for women in India increased from 1.2% in 1990 to 9.8% in 2022, and for men from 0.5% to 5.4%. According to NFHS-5, 24% of women and 23% of men in India are overweight or obese. India has more than 100m diabetic patients with an equal number in pre-diabeties. India is considered “diabetes capital” of the world.

Market for GLP-1s is still nascent in India but is growing rapidly evident by rapid growth in sales for Wegovy and Mounjaro. Mounjaro (priced at 14000-17500 per dose) has crossed Rs 100 crore in sales in India in just four months of launch, making it one of the country’s fastest-growing prescription brands ever by value.

A host of Indian companies are gearing up to launch semaglutide generics when the core patent expires in March 2026. Adoption of GLP-1s can be rapid in India, given India has over 100 million obese adults and another 180 million overweight individuals. Companies directly involved in supply chain - APIs, fill-finish, autoinjectors, manufacturers will be the obvious beneficiaries. As adoption for GLP-1s picks up, second-order effects will be visible across multiple industries like diagnostics, dairy/protein, hospitals, fast food chains, restaurants; however, these effects are likely to emerge gradually over the coming years.

patent expiry for GLP-1 drugs across markets

Company Molecule Brand Name Mode of administration First US Patent Expiry Canada Brazil India
Novo Semaglutide Ozempic Injectable 2031 Jan 2026 Mar 2026 Mar 2026
Novo Semaglutide Wegovy Injectable 2031 Jan 2026 Mar 2026 Mar 2026
Novo Semaglutide Rybelsus Oral 2031 Jan 2026 Mar 2026 Mar 2026
Eli Lilly Tirzepatide Mounjaro Injectable 2036 2036 2036 2036
Eli Lilly Tirzepatide Zepbound Injectable 2036 2036 2036 2036

Positioning of Indian Pharma companies in GLP-1s

company positioning
Shaily Engineering Leading manufacturer of pen injectors for GLP-1 therapies; capacity expanding from 40 to 100 million pens by FY28, and 34-35 million pen commercial supply (including semaglutide) targeted in H1 CY26
Gland Pharma fill-finish CDMO for peptides and GLP-1s; launched liraglutide in Q4 FY25 and aggressively scaling its integrated pen/cartridge capacity from ~40 million to 140 million units annually by 2026
Divi’s Laboratories leading peptide API partner for global innovators, offering both solid-phase (SPPS) and liquid-phase peptide synthesis (LPPS), with recently commissioned SPPS capacity and strong backward integration into high-purity peptide fragments ; actively expanding its portfolio in GLP-1 and related analogs, working with several innovators at multiple stages
Nueland Laboratories Over 15 years of proven expertise in peptide chemistry, including complex purification and large-scale capabilities; expanding peptide manufacturing from 0.5 KL to 6.37 KL; engaged on multiple peptide projects including late-stage/Phase-3 candidates in the CDMO pipeline
OneSource Specialty specializing in drug-device combinations with deep expertise in cartridge and fill-finish; expanding cartridge capacity from 40 million to 200 million units and upgrading sterile injectable infrastructure via $100 million capex focused on new drug-device lines and lyophilization
Lupin advancing its pipeline with internal and partnered development of oral and injectable Semaglutide targeting the first wave in India and select ex-India markets by FY27
Dr Reddy Global leader preparing Day-1 semaglutide launch across 87 countries including india, canada, brazil; building a robust global pipeline of peptides including GLP-1s
Sun pharma GL0034 (Utreglutide) Phase-1 completed showing promising weight loss results; ramping peptide manufacturing and has pen delivery partnerships to enable a Day-1 semaglutide launch in India
Glenmark pharma First to launch liraglutide biosimilar Lirafit™ in India, capturing over 65% share in the Indian liraglutide segment with ~70% lower therapy cost; expanding its GLP-1 and anti-diabetic injectable portfolio.
eris lifesciences developing synthetic and recombinant semaglutide with validation underway at its EU-GMP injectables sites; scaling up fill-finish capacity with a cartridge line at Bhopal, targeting one of the first GLP-1 launches in India/ROW from March 2026
torrent pharma gearing up for first-wave launches of both oral and injectable semaglutide in India from 2026; phase 3 trials for oral underway and injectable secured via partnership; building capabilities and IP in complex peptides
cipla Early-mover securing early partnerships for pen delivery and targeting launch by March 2026
zydus lifesciences targeting day-one launch of generic semaglutide in India and other emerging markets post-patent expiry
15 Likes

Great read @abhay.jain
But isn’t Natco pharma also a player in this space. As far as i know they also have an FTF for semaglutide.

I wrote in fair depth about GLP-1s and second order effects in August. After reading more on these drugs and feedback on that piece, I will spend some time covering the history of GLP1 drugs and some additional thoughts. Some of the names I discussed in that primer have done pretty well - AIRS is up 70% since that piece, and overall basket is up 17% since then. We are seeing increased traction of these drugs in India with Mounjaro crossing 100 crores sales in just 4 months.

One interesting insight from Thyrocare’s Q2 call on the impact of GLP-1 drugs:

From Gila monster venom to obesity and beyond

Novo Nordisk and Eli Lilly are historically pioneers in insulin products for diabetes. Insulin is a hormone produced in the pancreas to lower the level of glucose in the blood. Regular insulin must be injected before meals to avoid a peak in glucose in the bloodstream (dose and frequency depends on the severity of the disease). Type 2 diabetes (90%) is the most frequent form and usually occurs as a result of obesity and lack of exercise, but some people are genetically more at risk than others. The other 10% suffer mainly from Type 1 diabetes. T1D is an autoimmune disease which attacks the insulin producing beta cells in the pancreas, for which the main treatment is a full insulin replacement approach. T2D is a chronic disease that worsens over time and evolves quite slowly. After the first oral anti diabetes agents the end stage requires full insulinisation.

Insulin was discovered in 1921 by two scientific researchers from the University of Toronto and in 1923 Lilly and Novo manufactured the first products which saved lives of patients suffering from diabetes. Initially mostly extracted from pigs, insulin was subsequently produced as a recombinant protein in microbial organisms. But despite these improvements in manufacturing, no new injectable products were developed to treat patients with diabetes.

Insulin’s main side effect is hypoglycemia. This occurs because the molecule lowers the level of glucose in the blood even if it’s not high, so there is a need of a product with glucose-dependent effect on glycemia.

GILA MONSTER SALIVA

Scientific researchers observed that these lizards, which live in the Southwestern US and the Northwest of Mexico can eat only a few meals per season and that their toxic bite can kill a human being. During the 1990s, endocrinologists were looking for a hormone similar enough to the human’s gut GLP-1, identified in 1986 this hormone was attractive as it stimulated insulin only when blood sugar levels were high. However, endogenous GLP-1 has a short half-life (of just two minutes) as it is quickly degraded primarily by an enzyme called dipeptidyl peptidase-4 (DPP-4) and renal clearance. In order to extend its effectiveness, scientific researchers developed GLP-1 receptor agonists, such as exendin-4, which was initially found in the venom of the Gila monster.

Exendin-4 has the ability to stimulate insulin secretion and inhibits glucagon secretion by mimicking GLP-1 by stimulating the GLP-1 receptor and then reducing blood glucose levels. Exenatide, the first synthetic GLP-1, is the modified form of exendin-4.

FIRST-GENERATION PRODUCT PROFILE WAS NOT VERY ATTRACTIVE

The first company to successfully develop a product was Amylin Pharma, which in-licensed the product in 1996, then in 2002 partnered the product with Lilly. In May 2005, the drug was approved in the US under the name Byetta.

Byetta was not very popular due to its twice-a-day format, its delivery via a large needle and significant gastrointestinal side effects, for only moderate efficacy in lowering glucose levels. There were also concerns about rare cases of pancreatitis (still more frequent in patients with diabetes) and thyroid cancer (there is a black box warning).

So the prescriptions and sales were not high enough and in 2011 Lilly and Amylin ended their collaboration. However, they found another partnership, with BMS and AZN in 2012 via a JV in diabetes. But ultimately AZN purchased BMS’ share in the JV and became the sole owner of the business, thereby strengthening its presence in diabetes (which also comprises an oral product form in the new SGLT2 class: dapagliflozin, brand name Forxiga, which became a super blockbuster). The company developed with a partner (specialized in drug delivery technology), a once-weekly formulation of the molecule under the brand name Bydureon (exenatide extended release) launched in early 2012 (after an initial refusal by the FDA in 2010). But despite the more convenient formulation, tolerance was an issue.

Exenatide is a 39 amino acid peptide and with 50% homology to GLP-1s. However, as it is extracted from animals it has a poor tolerance profile and some immunogenic issues (patients developed anti-exenatide antibodies; for those with a high level of these antibodies (6%) half showed an attenuated efficacy on glucose control). Moreover, in addition to the usual gastrointestinal side effects (for the GLP-1s), the product causes injection site reactions, which is not the case with insulins (or with the next-generation GLP-1s).

Novo Nordisk and next generation GLP-1s

Novo had also worked in the GLP-1 space in the early 2000s, launching its first-generation GLP-1 in 2010 in the US (once a-day injectable: Victoza/liraglutide) with a better-tolerated profile, as the molecule was fully human (fewer allergic reactions or neutralising antibodies). The drug became the market leader until Lilly launched a new once-weekly product called Trulicity (dulaglutide), which enjoyed an attractive convenient and potent profile. Novo finally brought semaglutide to market three years later, the product that had the most attractive profile.

Semaglutide

Since its launch in 2017, semaglutide (brand name Ozempic & Rybelsus for type 2 diabetes launched in 2019, and Wegovy for weight-loss launched in 2021) has become the leading GLP-1 in diabetes and the company’s most significant growth driver. At the time of launch, it had the most attractive profile in terms of blood glucose control, weight loss, and cardiovascular benefit. It showed good differentiation vs insulin, DPP-4 (oral products from Merck&Co) or the first-generation GLP-1.

Wegovy

Given the success of (or at least the strong appetite for) its first generation product and the development of the once weekly GLP-1 semaglutide, Novo developed a high-dose format and launched the first potent (mid-teens weight loss) and convenient (once weekly injectable) obesity product.

In the meantime, Lilly developed a dual agonist approach with tirzepatide, which targets GLP-1 receptors plus (Gastric inhibitory polypeptide (GIP), and which shows strong efficacy (high teens when placebo adjusted at 72 weeks). Usually, when these products hit more targets, they show a synergistic effect on body weight reduction, but also this usually comes at the cost of more side effects, although these appear manageable.

The product reached the market at end-2023, and due to several factors (Novo supply constraints, versions available from compounding pharmacies, and the attractive profile) the product is gaining market share and has now captured more than 50% of total volumes in the US.

According to Novo, the reason for the lower number of new prescriptions of Wegovy is that compounding pharmacies mainly supply semaglutide (and little tirzepatide). However, from end May (three months after Wegovy’s removal from the FDA drug shortage list) the compounding pharmacies will no longer be allowed to sell Wegovy (Novo will take all the regulatory measures to prevent compounding pharmacies from selling the drug).

ADHERENCE TO TREATMENT: AN ISSUE IN THE OBESE POPULATION TO MAINTAIN EFFICACY

Adherence to chronic treatments is usually not good, especially when the disease is not symptomatic. Obese patients in the real world tend not to be very compliant and not to follow the lifestyle change recommendations needed to show the promise delivered during clinical trials. In 2023, Novo reported the level of its products used by patients after one year, and i found this surprisingly low for drugs for which demand is high. According to the company, the low adherence to obesity treatment in the US is due to a shortage of its Wegovy drug. But the curves are almost parallel for its Saxenda (liraglutide) and Wegovy products.

As Wegovy is supposed to be a very potent and well tolerated product, we would have anticipated a much greater difference. If the level of use after one year is so low, it is probably also due to the profile of the products. And, in my view, it has to do with the GI tolerance at initiation and over the long term in chronic use, the convenience (injection and titration period of 16 weeks), and the need for lifestyle changes to show meaningful and sustained weight loss. Having said that, according to Novo, the adherence has been improving over time. The figure is slightly higher in patients with T2D at closer to 45-50%

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Lowering of product prices. This would force our formulation players to cut down their pricing. Seems that the beneficiaries would be amongst the API players and Hospital chains due to early adoption by large population and thus not many in the Formulation players due to pressure on their pricing.

Generic drug companies rework pricing to gain weight in India’s GLP-1 market as Novo Nordisk slashes Wegovy prices - The Economic Times