After splash in 2025, weight-loss drugs poised to take off this year

Metabolic medicine dominated the health headlines in 2025 — and looks set to do so again in 2026.

In 2025, GLP-1 weight-loss drugs, a new class of medications, entered the Indian market. In March, Eli Lilly launched Mounjaro (tirzepatide) and Novo Nordisk followed with Wegovy (semaglutide) in June. Within months, the conversation shifted from clinical promise to commercial success.

Despite limited uptake, these drugs vaulted into the top tier of India’s pharmaceutical market by value, ranking just behind GSK’s antibiotic Augmentin, according to industry estimates. The explanation lies in price — and in who is paying.

GLP-1 drugs are largely funded out of pocket. Their early success signals something larger than a blockbuster launch: a change in patient behaviour. Indian consumers, accustomed to conservative management of chronic conditions like obesity and diabetes, are increasingly willing to pay for relatively expensive, long-term metabolic treatment. That willingness has turned a small patient base into a big market.

Clinically, however, the story is still incomplete. Many important questions remain unanswered: What happens when patients stop taking these drugs? And can they stop at all? Early global evidence suggests weight regain is common, though not necessarily complete. Indian data is scarce.

“It is simply too early for firm conclusions,” says Dr Nikhil Tandon, head of endocrinology at AIIMS, New Delhi. Logic and overseas studies suggest some rebound is likely, though outcomes vary widely depending on behaviour after treatment ends.

More practical questions loom just as large: whether therapy should continue after target weight is reached, whether doses can be reduced, or whether treatment breaks are safe. These uncertainties will begin to be addressed only this year.

While long-term weight-loss questions remain open, the cardiovascular evidence is already firmer. Dr Ambuj Roy, professor of cardiology at AIIMS, says the strongest data relates to two conditions: coronary artery disease and heart failure with preserved ejection fraction — a form of heart failure more common in the West but increasingly seen in India as the population ages. This is seen particularly among people with longstanding diabetes and hypertension.

In the case of coronary artery disease, he argues, GLP-1 drugs appear to be disease-modifying. “Like aspirin or statins, they seem to change the underlying disease process, not just treat symptoms,” he says.

Interest in this aspect intensified in 2025 after a Lancet study reported that semaglutide reduced the risk of major cardiovascular events — heart attack, stroke and cardiovascular death — in people with obesity and established heart disease, even in the absence of diabetes.

The benefit was observed across different levels of baseline body weight and was not fully explained by the amount of weight lost during treatment. Although reductions in waist circumference, a marker of abdominal fat, were associated with better outcomes, they accounted for only part of the effect. This suggested cardiovascular protection beyond weight loss alone. Dr Roy cautions, however, that all participants in the study had significant central obesity. “The evidence is strong for people with coronary artery disease who are clearly overweight,” he says. “For leaner individuals, we simply do not yet have data.”

Yet, the most consequential developments next year may occur not in clinics, but in pharma manufacturing units and courtrooms. Novo Nordisk’s grip on semaglutide in India is loosening. The primary patent on the molecule expired in September 2024, enabling Indian manufacturers to produce generic versions for export. A secondary patent, covering formulation and injection devices, remains in force until March 2026 — effectively blocking domestic sales of injectable generics. Its expiry will mark the real inflection point.

Several Indian drugmakers are positioning themselves for that moment. Dr Reddy’s, Sun Pharma, Cipla, Lupin, Biocon, Zydus Lifesciences and Aurobindo are all developing semaglutide products or expanding capacity. Biocon plans to seek approval for a generic Wegovy, potentially launching in 2027, while Ajanta Pharma has partnered with it for overseas markets. Once generics enter India, prices are likely to fall sharply and expand access.

Regulation will be another important aspect. In the US, GLP-1 drugs are rapidly being redefined as broad metabolic therapies. Semaglutide is now approved not only for diabetes and obesity, but also to reduce cardiovascular risk, slow diabetic kidney disease and treat certain patients with fatty liver disease. Tirzepatide has been approved for moderate-to-severe obstructive sleep apnea in adults with obesity. India, in contrast, still limits approvals to diabetes and obesity, though manufacturers are expected to pursue broader indications.

Beyond current products, investor enthusiasm is increasingly focused on the next generation of metabolic drugs. In August, Eli Lilly reported that its once-daily oral GLP-1 pill, orforglipron, helped adults with obesity lose up to 27.3 pounds in a Phase 3 trial.

Another is potency. Novo Nordisk’s CagriSema, a once-weekly injection combining semaglutide with cagrilintide, targets two hormonal pathways simultaneously. Early data suggests greater weight loss than semaglutide alone, alongside reductions in blood pressure — an attractive combination for cardiometabolic disease. In December, the company sought approval from the US FDA.

A third frontier lies in multi-receptor drugs. Mazdutide, developed by Innovent Biologics with Eli Lilly, targets both GLP-1 and glucagon receptors. Approved in China in 2025 for diabetes and weight management, it remains in clinical development elsewhere, with years to go before regulatory filings in markets such as India or the West.

Taken together, these trends point to a broader shift. What began as a weight-loss story is fast becoming a restructuring of metabolic medicine — and, in India, a test of how pricing, patents and patient willingness to pay will shape access.

India’s public health agenda in 2026: TB, HPV and cancer care

India had set 2025 as the target year to eliminate tuberculosis, aiming to achieve this milestone five years ahead of the global target. The ambition remains unfulfilled.

According to the Global TB Report 2025, India’s TB burden continues to decline — an estimated 2.71 million cases and 300,000 deaths were recorded in 2024 — but elimination remains distant. Between 2015 and 2024, India cut TB incidence by 21% and deaths by 28%. This falls well short of the World Health Organization’s (WHO) 2025 End TB targets, which call for a 50% reduction in incidence and a 75% reduction in deaths compared with 2015. By last year, India had achieved only about half of the 2020 global milestone (20% reduction in incidence, 35% reduction in deaths).

Yet there is cause for cautious optimism. TB treatment coverage improved significantly in 2024. Roughly 92% of estimated TB patients were diagnosed and started on treatment, up from 85% in 2023. As India enters 2026, progress on TB will remain one of its most closely watched public health stories.

A second initiative to watch is the planned rollout of a national HPV vaccination campaign. Cervical cancer, the second most common cancer among Indian women, claims 75,000 lives annually and affects approximately 1,25,000 women each year. More than 95% of cases are linked to persistent infection with high-risk strains of HPV, making vaccination a highly effective prevention measure. Training of ground-level implementers has begun, though key details — including the vaccine type, dosage schedule and launch date — remain undecided. Officials suggest a final decision will come in the first half of 2026.

Finally, India is set to expand cancer care access through Day Care Cancer Centres in district hospitals. Announced in the 2025-26 Union Budget, the government plans to establish at least 200 centres in the current financial year, with a full rollout over the next three years. High-burden districts have been prioritised. These centres, which will provide chemotherapy, essential medications, minor procedures and complication management, promise to decentralise cancer care. This is significant for rural populations, who travel to cities for treatment at a high cost. With one in nine Indians expected to develop cancer in their lifetime, and cancers such as oral, lung, and esophageal in men, and breast, cervical, and ovarian in women, these centres could meaningfully improve early access to cancer care.