A drug that outperforms placebo in helping people to lose weight is one of a growing number of next-generation obesity drugs being produced in China.

At first, Chinese pharmaceutical companies rushed to make similar versions of blockbuster weight-loss drugs, such as Wegovy and Ozempic, that have taken the world by storm. Nowadays, China is emerging as important innovator for new drug discovery in this field, says Daniel Drucker, an endocrinologist at the University of Toronto in Canada.

Results from a phase III trial of ecnoglutide show that people receiving a weekly injection of the drug lost up to 13.8 kilograms over 48 weeks of treatment. By contrast, people given placebo injections lost around 200 grams. The results were published in The Lancet Diabetes and Endocrinology on 21 June.

Ecnoglutide is a glucagon-like peptide-1 (GLP-1) receptor agonist analogue, similar to the blockbuster obesity drug semaglutide. These drugs mimic the hormone GLP-1, which is involved in regulating appetite and managing blood-sugar levels. Unlike semaglutide, ecnoglutide preferentially targets the production of cyclic adenosine monophosphate, a messenger molecule associated with regulating glycogen, sugar and lipid metabolism, which helps to control blood-sugar levels, as well as weight loss.

The study, funded by drug manufacturer Sciwind Biosciences, based in Hangzhou, China, included 664 people given either a weekly injection of a placebo, or one of three doses of ecnoglutide. At the maximum dose of 2.4 milligrams, 92.8% of people lost at least 5% of their body weight, compared with 14% of people receiving placebo injections. People receiving ecnoglutide were also able to maintain their reduced weight after stopping treatment, regaining around 1% of their body weight over a 7-week period.

Linong Ji, a co-author and a diabetes researcher at Peking University People’s Hospital in Beijing, says ecnoglutide also improved risk factors for heart disease and diabetes, and reduced the amount of fat in people’s livers.

More drugs to come

Dozens of GLP-1 drugs are being developed and tested in China, with “many more to come”, says Drucker.

Among them is mazdutide, which mimics GLP-1 and glucagon, a hormone involved in blood-sugar levels. In trial results published in May, a weekly injection helped more people to lose up to 15% of their body weight over 36 weeks and reduced the risk of cardiovascular diseases compared with a placebo treatment.

Developed by Eli Lilly in Indianapolis, Indiana, mazdutide is manufactured by Innovent Biologics in Suzhou, China, under an exclusive licence. Other trials are testing whether the drug can treat sleep apnoea or type 2 diabetes.

The growing number of new GLP-1 drugs target multiple pathways at the same time so will result in more-tailored treatments, says Sof Andrikopoulos, a diabetes researcher at the University of Melbourne. The next generation of drugs will target specific conditions associated with diabetes and obesity, such as sleep apnoea, fatty liver disease, chronic kidney disease and heart disease, he adds. “It’ll give us options and it will make personalized medicine in obesity and diabetes more accessible.”

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