Last Wednesday, Novo Nordisk announced its first quarter 2025 financial report, with sales of Smegglutide reaching 55.776 billion Danish kroner (approximately US$8.41 billion, or approximately RMB 60.8 billion), a year-on-year increase of 32%, accounting for 71% of Novo Nordisk's total revenue. [1]

According to Merck's first quarter financial report, K-drug, which had sales of the top 1 globally, had revenue of US$7.205 billion last year. [2]

Source: Reference 2

In the first game in 2025, Simei officially surpassed K medicine and became the throne of the world's "King of Medicine".

K medicine’s “Drug King Experience Card” may expire

In this "Drug King" battle in 2024, the final victory and defeat was extremely dramatic: the huge amount of RMB 200 billion, and the final decisive gap was only 0.6%.

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Source: Internet emoji package

Faced with the top drug king K medicine in 2023, Simegglutide, with the title of "the hottest weight loss needle", chased the sales gap of US$1 billion in the second half of 2024, but in the end it still ranked second with a difference of US$186 million.

This war without gunpowder was very thrilling from the beginning.

K drug, Keytruda, Merck's Pembrolizumab injection, is a big star in the field of cancer PD-1 inhibitors.

10 years ago, in September 2014, K drug was first approved for marketing by the US FDA for patients with advanced malignant melanoma, becoming the second PD-1 drug approved for marketing in the world. In terms of time, Merck may only say that it has not lost the opportunity, but in terms of expanding indications after launch, K medicine is very successful.

Merck obviously attaches great importance to this breakthrough in the PD-1 field, and intends to transform K-drug from a "storm boat" into an "aircraft carrier" by creating the world's largest clinical research project in immuno-oncology.

Within ten years, nearly 40 indications have been approved for marketing worldwide, and the number of indications approved in my country has reached 13, making it the PD-1 inhibitor with the most approved tumor treatments.

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Source: K Medicinal Medicinal Guide

Every expansion of indications brings a significant increase in the number of applicable patients, and the market will expand at an accelerated pace. In its fourth year alone, K-drug's sales reached US$7.2 billion, ranking fifth in the world's best-selling drug.

By 2023, K-drug has generated a total of US$101.5 billion in revenue for Merck in 9 years. It is not only Merck's pillar, but also the ceiling of anti-tumor drugs, but also pushes K-drug to the forefront of the "Drug King" dispute - kicking away the ten-year-old drug king Xiumeile.

From January to February 2024, major multinational pharmaceutical companies (MNCs) successively released their financial reports for the previous year, and K-Pharma successfully rose to the top with US$25.011 billion (approximately RMB 179.6 billion).

But soon, K medicine ushered in another strong opponent: semegglutide.

The rising star Simi was a little short last year

In fact, after K medicine became the throne of the King of Medicine, many people believe that what it got was just a "1-year experience card".

The reason is nothing more, just because semegglutide is too strong.

Smegglutide is a GLP-1 receptor agonist, a drug with lowering glycemic and weight loss. Currently, there are three products.

One is Ozempic, once a week, 0.25mg, 0.5mg or 1mg each time. It was originally used as a diabetes treatment drug. It was launched in the United States at the end of 2017 and was launched in China in April 2021. It will be included in the national medical insurance negotiation catalog after half a year.

In April 2021, another Simegglutide injection, Wegovy (1 time a week, 2.4mg), was approved by the US FDA for "overweight or obesity" and was approved by the National Medical Products Administration in June 2024 under high expectations.

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Source: Reference 1

There is also an oral preparation, Rybelsus, which is indicated by diabetes. It was approved by the FDA in September 2019 and approved by the China National Medical Products Administration in January 2024. It is the world's first and only oral GLP-1 receptor agonist drug.

With excellent weight loss effects, smegglutide quickly became a phenomenal drug as soon as it was launched, and even suffered a global shortage in 2022, lasting more than one year.

Even in 2023, many people believed that if it weren't for the production capacity issue, semegglutide might have been able to intercept K drugs.

That year, Novo Nordisk's financial report wrote that sales in the treatment of diabetes and obesity increased by 29% to 156.4 billion Danish kroner (about RMB 164.8 billion); the growth in the treatment of obesity increased by 101% [3].

Moreover, sales have crossed the threshold of $20 billion from $10 billion, and K has been used for 3 years, while Simi has only taken 1 year.

With the focus on solving the production capacity problem, in 2023, Novos for weight loss soared by 407%, reaching US$4.6 billion; the total revenue of Smegglutide was 145.811 billion Danish kroner, totaling US$21.2 billion, losing to KP by 3.8 billion [3].

Until the end of 2024, the sales gap between Simegglutide and K drugs directly narrowed from US$1.2 billion in the first half of the year to US$186 million. Simegglutide in the second half of the year actually won, but it just happened to have not filled the gap in the first half of the year.

2025: Can Simei hold on with the turn of the show at the beginning of the year?

The stalemate situation continued directly into the first quarter of 2025.

According to Novo Nordisk's first quarter 2025 financial report, the total sales of Smegglutide-related products are as follows:

Ozempic, which is indicative of diabetes, Q1 sales were 32.721 billion DKK, up 15% year-on-year;

Rybelsus, an oral preparation for diabetes indication, had Q1 sales of DKK 5.695 billion, a year-on-year increase of 13%;

Wegovy, who is indicative of obesity, performed even more impressively, with sales of 17.36 billion Danish kroner in Q1, a year-on-year increase of up to 83%.

Overall, Smegglutide Q1 sold a total of 55.776 billion Danish kroner (approximately US$8.41 billion).

Even so, sales of Ozempic and Wegovy drugs remained lower than in the fourth quarter of last year.

Novo Nordisk said this is due to the widespread supply of compound GLP-1 drugs in the U.S. market, squeezing the market for both drugs. Therefore, the company lowered its sales growth forecast for 2025 by 3 percentage points and lowered its operating profit expectations by 5 percentage points.

However, the good days in the United States, which is combined with GLP-1 drugs, are over. The US FDA officially deleted semegglutide from the drug shortage list in February this year, and the production of complex drugs was completely stopped, and this part of the market will return to Novo Nordisk again.

However, the throne of Medicine King is not easy to sit firmly.

Looking back at the biggest killer of the past medicine kings is the loss of patent protection.

In 2028, the amino acid sequence of the core patented compound of K drug will expire in the US and Chinese markets and lose protection. Nearly 10 pharmaceutical companies' biosimilars have entered the clinical trial stage.

In this regard, semegglutide may be more urgent. In 2026, the original patents of semegglutide in China and India will expire, and any companies with some ability to develop polypeptide drugs are already preparing. The four major generic drug giants in India have all announced their end.

According to the Insight database in China, more than 20 domestically produced "smegglutide" have entered the approved clinical stage or above.

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Source: Insight Database

In addition to these generic drugs, there are also a large number of GLP-1s in the market that divides semegglutide. For example, tielpoptide, which is known as the strongest rival of semegglutide in the industry.

Telpopeptide is the world's first and only GIPR/GLP-1 dual-target agonist. Its launch process in China is very rapid. The indication for type 2 diabetes was approved last May and the indication for weight loss was approved on July 21 - it can be said that the poor progress was almost recovered.

Data shared by Novo Nordisk in a PPT show that in the United States, Eli Lilly's Tirzepatide sales momentum has continued to surge in recent years, and the threat to Novo Nordisk is intensifying.

Source: Reference 4

At the same time, the two major oligarchs of GLP-1 have also begun to open up new battlefields.

Last month, Eli Lilly said it was expected to submit an application for weight management indications for oral Orforglipron to global regulators at the end of this year and submit its application for type 2 diabetes in 2026.

Subsequently, Novo Nordisk, who was unwilling to fall behind, immediately stated that he had submitted an application to the FDA for the treatment of overweight or obesity. If approved successfully, this may be the world's first oral weight loss version of GLP-1 drug.

In this situation where there are interceptions and pursuers afterwards, it is still unknown whether Simei can completely rewrite the times and firmly sit in the top spot in 2025. (Planning: z_popeye｜Producer: islay)

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