oral vs injectable GLP-1, why is the oral version such a hard problem?
Peptides get destroyed in the gut, which is why almost everything in this space is injected. Getting an oral version to work is a real pharma achievement, not a formulation convenience.
Two different approaches worth separating:
1. Oral peptide with an absorption enhancer. The peptide is unchanged, a co-formulated agent helps it cross. Bioavailability is still low and variable, which is why the administration conditions matter so much for these.
2. Small molecule agonists. Not peptides at all. Designed from the start to be orally available. Completely different manufacturing economics, which matters for supply.
The second category is the more interesting one long term imo, because peptide manufacturing capacity has been a genuine constraint on the whole class.
Status: an oral peptide formulation is approved for specific indications, the small molecules are at various stages, some with phase 3 data.
Am I overrating the small molecule angle?