The lull before …

The lull before …

The stores are boarded up, the police are on alert as everyone waits for this election to come and hopefully go. Never before have we gone into an election where one of the candidates has indicated he may not relinquish power if he loses and millions of voters on both sides wonder if they can trust the results. Early voting is setting records, mail in voting is way up and in the midst of a pandemic millions more will head to the poll’s tomorrow. Whatever the outcome let’s pray for a peaceful day and hopefully a non-contestable outcome which does not end up in the courts. To all who have voted and to those going to the polls tomorrow thank you for honoring America and having your voice heard.

Now onto to business which for us means doing a little catch up as Novo Nordisk did report results last week and with all the other items going on we never got throw in our two cents. While we did not listen to the call we did read the transcript and all the supporting material. And thankfully we weren’t surprised by anything we read, Novo’s transition to a GLP-1 company first insulin second continues. Business is doing just fine and while there was bad news in the pipeline nothing that should send shockwaves.

The area that was of most interest to us was how Rybelsus® was doing. As we had noted in the past launching any new drug isn’t easy but launching one during a worldwide pandemic is next to impossible. Rybelsus being the first orally administered GLP-1 is a test case of sorts. The drug comes with a rather complex dosing regimen yet with all the benefits of an injectable GLP-1. The question we had wasn’t whether physicians would prescribe Rybelsus rather who would they prescribe it to and how would these patients accept the dosing regimen.

From the start and our minds have not changed here the early data for Rybelsus is less important new prescription stats will tell the story here. The story will be told IF patients refill their scripts, that will tell whether the dosing regimen is worth the hassle. And YES, it is that simple. Novo should be given a great deal of credit for handling the many obstacles that have been thrown in front of the launch. The jury is still out on the drug but so far so good.

One area that we continue to marvel at is the results in obesity. This perhaps is one of the best moves ever by Novo as they took a drug from diabetes Victoza repositioned it for obesity as Saxenda® and this repositioned drug has become a blockbuster. No matter what Saxenda does moving forward the results are just cherries on top of the GLP-1 ice cream.

Since this Novo we suppose we have to say something about insulin which should tell everyone just how much insulin is an afterthought and not just for Novo but Lilly as well. The next battle in the insulin market between these two heavyweights will not come over some new insulin formulation rather over whose version of Tyler is better. While Novo and Lilly continue to move at glacial speed getting their respective Tyler from development to market, Medtronic just mighty light a fire under the ice when they launch their Tyler with their own biosimilar long AND short-acting insulin.

The one glaring weakness for Novo continues to be their pipeline, there are some interesting compounds in very early stages but nothing that will compete against Tirzepatide from Lilly. It will be interesting to see if the company fills this hole via acquisition.

All in all Novo like Lilly has weathered this first phase of COVID just fine. With the pandemic showing renewed signs of life we anticipate lessons learned from phase one to be very valuable. These two heavyweights continue to battle each other the only thing that has changed is the venue now the fight is over GLP-1 supremacy. Other than it it’s business as usual or as usual as it can be during a pandemic.