This article is authored by Dr. Bryan Chow, a consultant with GenInnov. Dr Chow is a physician by training.
Few global health issues illustrate market paradoxes better than non-alcoholic fatty liver disease. About 830 million people worldwide live with diabetes[WC1], and more than 2 billion adults globally are considered overweight. [WC2] The numbers are staggering, not only for their scale but for their impact on healthcare systems and economies. In 2023, global sales for diabetes drugs alone surpassed $60 billion. [WC3] Meanwhile, the new wave of weight loss drugs—led by GLP-1 agonists—has set financial markets ablaze, with analysts predicting annual sales for anti-obesity medications could exceed $100 billion within a few years.[WC4]
In tandem with the obesity public health crisis, metabolic-driven fatty liver disease (now known as MAFLD, previously NAFLD) is almost as common, and estimated to affect one in three adults globally—about 1.2 billion people. [WC5] In China alone, prevalence in urban areas has doubled over the past decade, impacting up to 30% of adults. [WC6] Unlike diabetes or obesity, however, fatty liver disease remains under-addressed. There are virtually no established prescription-related therapies. The general medical consensus on treatment remains the twin advice of dietary and lifestyle improvements. As a consequence, this is one of the most prevalent conditions on the planet where investors and analysts have no clear way to forecast the potential revenue pool.
This situation exists partly because the disease has expanded so rapidly, with medical management subsumed under broader chronic metabolic treatment guidelines. It’s also because, for most patients, fatty liver disease is mild and may not cause clinical symptoms in the early years, leading to widespread nonchalance rather than active intervention. But perhaps the biggest reason is simply a lack of viable therapies—unlike diabetes or obesity, there is nothing specific for fatty liver that clinicians could prescribe. This has kept the commercial market hidden, despite the fact that the potential health and financial impact is enormous, given the scale and long-term risks associated with fatty liver disease.
When Waiting Is the Default: The Long Shadow of A Condition in Therapeutic Limbo
The clinical reality for most people diagnosed with fatty liver has, for decades, been a waiting game. Fatty liver is most often picked up incidentally, through routine imaging or blood tests, and unless there are obvious complications, doctors generally recommend lifestyle changes rather than prescriptions. The idea is to manage weight, improve diet, and increase exercise—advice that is sound, but for many, difficult to maintain long-term.
Such an approach became entrenched, given that there was no proven, specific pharmacotherapy for fatty liver. In stark contrast to diabetes, where clear guidelines and a spectrum of drugs exist, from metformin to SGLT2 inhibitors to GLP-1 receptor agonists, patients with fatty liver are left in limbo. Despite the high global prevalence of this disease, active intervention remains rare.
Furthermore, from a clinical standpoint, fatty liver is a spectrum disorder. About 70–80% of patients will have only simple steatosis, a benign fat accumulation in the liver. But 20–30% may develop inflammation (known as NASH or MASH), and a subset of those progress to scarring (fibrosis), cirrhosis, or liver cancer over decades[WC8] . [WC9] While most do not progress, the absolute number who could increase simply because the baseline prevalence is so high. This slow, and sometimes unpredictable, progression is part of why the pharmaceutical industry has been slow to prioritize fatty liver. Yet, the market could shift dramatically with even modest improvements in treatment.
Fatty Liver, Diabetes, and Obesity: Related, But Not the Same
The relationship between fatty liver disease, diabetes, and obesity is close, but not interchangeable. All three are manifestations of metabolic dysfunction, and their prevalence curves have risen in parallel as global diets have become more energy-dense and lifestyles more sedentary. It’s tempting to think that solving one would solve the others. However, the evidence suggests otherwise.
Weight loss is consistently shown to improve liver health, and intensive diabetes control is beneficial. But the biology of fatty liver is unique. The liver plays a central role in glucose and lipid metabolism, and excess fat can accumulate independently of body weight or diabetes status. A study in 2019 recognised that NAFLD also occurs in individuals who are not obese, especially in Asian populations —meaning lean individuals can still have significant fatty liver disease. [WC10] This distinct biology is one reason why drugs that work for diabetes or weight loss may not always translate into effective treatments for fatty liver.
The last decade has seen a wave of “metabolic drugs” that promise to change this landscape. Semaglutide (marketed as Ozempic for diabetes and Wegovy for weight loss) and tirzepatide (Mounjaro for diabetes, Zepbound for obesity) have demonstrated not only impressive effects on weight and blood sugar but also reductions in liver fat and inflammation in clinical trials. [WC11] Still, these drugs are not specifically approved for fatty liver disease, and the magnitude of liver benefit, while real, is not always as pronounced as the effects on weight or glucose.
Recent FDA approval of resmetirom (Rezdiffra) for noncirrhotic NASH with fibrosis is a significant step forward, with trials showing liver fat reductions of at least 30% and improvements in fibrosis. [WC12] But the disease’s complexity means that a “one size fits all” approach is unlikely to work. The market could likely evolve to include both broad metabolic drugs and dedicated fatty liver agents.
A Market With No Map: Why No One Knows the True Potential
One of the strangest aspects of fatty liver disease is how its commercial potential is both obvious and invisible. With diabetes and obesity, drug sales are already established: Novo Nordisk’s GLP-1 franchise (Ozempic, Wegovy) delivered over $33 billion in revenue in 2023[WC13], while Eli Lilly’s Mounjaro is projected to become one of the best-selling drugs in history, targeting both diabetes and obesity. Yet for fatty liver, there is no real-world benchmark. There are no particular targeted drugs, and essentially no forecasts in Wall Street models.
Part of the reason is regulatory: the lack of approved drugs for most of the disease’s history meant there was nothing to model. But the greater reason is the clinical inertia described above—most patients are underdiagnosed[WC15]. Furthermore, even when identified, many cases have no access to definitive intervention beyond lifestyle advice. The commercial market is a blank slate, hiding a potentially enormous revenue pool.
The real tipping point will come when new drugs demonstrate not only efficacy in clinical trials but also cost-effectiveness and safety in real-world use, prompting guideline updates and wider screening. Even a modest uptake could create a market rivaling diabetes or obesity drugs. Investors and analysts should watch for moments when clinical guidelines, patient demand, and regulatory approvals align, as this is when a ‘blue ocean’ market could emerge almost overnight.
Molecules, Markets, and Brands: Why Diabetes and Weight Loss Drugs Are Split
A fascinating lesson from the recent GLP-1 revolution is the way pharmaceutical giants separate branding and market positioning for diabetes versus obesity, even when the underlying molecule is nearly identical. Novo Nordisk sells semaglutide as Ozempic for type 2 diabetes and as Wegovy for weight loss, with different dosing and pricing strategies. Eli Lilly follows a similar playbook, marketing tirzepatide as Mounjaro for diabetes and as Zepbound for obesity.
This distinction is not trivial. It reflects differences in regulatory approval, insurance reimbursement, and patient populations. Diabetes drugs are often covered by health systems as essential therapies, while weight loss drugs have historically faced greater skepticism and health technology agencies’ cost-effectiveness acceptability curve restrictions, though that is rapidly changing as the health and economic burden of obesity becomes clearer. The dual-brand strategy allows companies to maximize reach and pricing flexibility.
For fatty liver disease, this commercial segmentation is even more profound: there is not yet a recognized, insured drug market at all. This means the first effective therapies will have the unique challenge and opportunity of creating the category from scratch. It’s a rare situation where companies and investors can shape not just drug sales but the very boundaries of a new therapeutic market.
Mazdutide and the Promise of Next-Generation Therapies
Within this landscape, China’s Innovent Biologics - a company in our portfolio - has emerged with one of the most intriguing candidates: mazdutide, a dual GLP-1 and glucagon receptor agonist designed to address both obesity and liver fat. In the GLORY-1 clinical trial, mazdutide was reported to reduce liver fat content by 80% over 48 weeks—far beyond the 30–40% reductions seen with semaglutide (Ozempic/Wegovy) or tirzepatide (Mounjaro/Zepbound[WC16] ). [WC17] [WC18] This figure comes from an exploratory analysis and needs confirmation in larger, more diverse populations, but even a conservative reading points to a step-change in efficacy.
Mazdutide is currently under regulatory review in China for obesity, and additional studies are underway specifically for fatty liver disease (MAFLD/NASH). The molecule is also being evaluated for diabetes, giving it potential across all three of these massive markets. If the 80% figure holds up, mazdutide could quickly become a standard of care in China and possibly set a new benchmark worldwide.
For investors and the healthcare community, this is an opportunity to witness—and possibly influence—the birth of a new market. With China’s rapid regulatory evolution and enormous population at risk for fatty liver, the commercial potential is unmatched by any other disease area outside of diabetes and obesity.
Table: Summary of Candidate Drugs and Reported Liver Fat Reduction
Percentages refer to reductions in liver fat content as observed in clinical trials or meta analysis. Figures may vary by population, dosage, and trial design.
Beyond the Molecule: Innovation, Valuation, and the Analyst’s Blind Spot
Innovent Biologics is much more than a one-drug story. The company’s pipeline is among the broadest in Asian biotech, reaching across oncology, immunology, metabolic, and cardiovascular spaces. Yet, as is often true for major non-Western innovators, its scientific advances frequently get little attention from the financial community and media, especially in regions where investors are more focused on established narratives than on what’s quietly happening in the lab.
This past week, the GLORY-3 study made headlines, but the reaction among analysts was telling. Despite the headline-grabbing numbers, the market’s attention was overwhelmingly on weight loss, with barely a nod to the liver fat reduction data. To be honest, the fatty liver claims from Mazdutide are not new—they have been consistent since the earlier GLORY-1 results several quarters ago. What is different is that each subsequent study continues to replicate these impressive findings, suggesting a growing base of evidence rather than a single lucky result. Still, there is almost no real conversation among analysts about the potential implications of these claims for the massive, currently untapped market in fatty liver disease. The collective silence is especially striking considering how prevalent and under-treated this condition is.
Part of the explanation is straightforward: Innovent itself, like its global peers, has been clear in positioning Mazdutide first and foremost as a weight loss drug, not a fatty liver therapy. The messaging, both from the company and from most media, keeps the focus squarely on obesity and related metabolic endpoints. So, even though the repeated, robust fatty liver data would in theory be enough to warrant deeper analysis, it remains a footnote. There are no widespread debates, no scenario models, and no visible recalibration of future market potential in the analyst community.
In other geographies, even a hint of disease-modifying effects in a common, underserved condition like fatty liver would have triggered at least a burst of alternative analysis and “what-if” thinking. Here, the silence speaks volumes—not necessarily about the science itself, but about how new therapeutic opportunities can stay invisible, sometimes for years, until a shift in perception finally occurs. The lesson is that the next blockbuster opportunity may be hiding in plain sight, its potential growing with each new dataset, but destined to be recognized only after the fact by most of the market.
Conclusion: The Next Chapter in Chronic Disease and Investment
Fatty liver disease is a global giant hiding in the open. It is every bit as prevalent as diabetes or obesity, and in some regions, even more so. Yet because it has lacked a therapeutic solution, it has never developed into a recognized drug market. The coming years may change that, as new molecules like mazdutide and resmetirom break through clinical and regulatory barriers, creating entirely new commercial categories in the process.
For Innovent, this is not just a story about one drug but about redefining the possibilities for Chinese biopharma on the global stage. And for investors and the finance industry, it is a lesson in the value of independent, deep research and a reminder that the world’s biggest market opportunities are sometimes the ones that haven’t yet been measured.
This article is for informational purposes only. Drug efficacy and approval status may change with ongoing research and regulatory decisions. Patients should consult a healthcare professional for medical advice.
