There are over 100 drugs in the obesity pipeline, with two pending Food and Drug Administration (FDA) approvals this year. Novo's oral semaglutide, which is already approved for diabetes as Rybelsus, is expected to be approved for obesity in November. The drug may have some limits on how much you can take (like Rybelsus). You must take it first thing in the morning, without eating or drinking anything, and then wait 30 minutes before eating or drinking anything else or taking other medications.
Lilly’s oral orforglipron product may also receive approval by the end of 2025, and both are expected to launch in early 2026. Orforglipron is a non-peptide GLP-1 agonist, but won’t require refrigeration. Orforglipron isn't expected to have the same dosing restrictions as oral semaglutide, but gastrointestinal side effects are the most common for both drugs. IPD Analytics says the new oral products may cost the same as the existing injectable drugs, but that's not clear yet.
Pharmaceutical companies are now focusing on next-generation treatments that combine GLP-1 with other hormones (like GIP and glucagon) to improve outcomes, personalize care and address related health conditions such as diabetes, liver disease and heart disease. New drugs in development aim to increase fat loss while maintaining muscle, and some use artificial intelligence to accelerate innovation.
Emerging biotech partnerships and novel therapies, like multi-hormone drugs and metabolic gene silencers, are expected to shape the next wave of obesity care. Some advancements might be available within the next few years.
| Drug | Characteristics | Potential advantages |
|---|---|---|
| Retratrutide | GLP-1, GIP, Glucagon | More weight loss than tirzepatide and improved blood pressure, blood sugar lipids and liver function |
| Caraglutide | GLP-1, GIP and an antibody compound | Monthly injection, although trial showed less weight loss than semaglutide and tirzepatide |
| Amycretin | GLP-1 amylin | Large weight loss (in small trials so far) |
| Cagrisema | Semaglutide and an amylin analogue | Weight loss and improvement of blood sugar and HbA1C |
| Oral Semaglutide | GLP-1 | Filed for FDA approval for weight loss; already marketed for diabetes |
| Orforglipron | GLP-1 small molecule | Requires no cold storage |
| Icosema (and others) | GLP-1 and insulin | Reduces injections for those with diabetes |
| Apitegromab (a drug added to GLP-1s and not of this class) | Myostatin inhibitor | Led to better preservation of lean muscle mass when added to tirzepatide |
Other conditions now being evaluated for GLP-1 effectiveness include:
These drugs are also being tested for obsessive-compulsive disorder, opioid use disorder, gambling and other mental health diagnoses, although these aren't mentioned in this review. This review also doesn’t mention that GLP-1 drugs are associated with decreases in many types of cancer when used to treat diabetes.
Current GLP-1 therapies, while effective for weight loss, have limitations that researchers are working to address. These include issues related to tolerability, efficacy and the potential for lean muscle loss. The industry is exploring new and improved treatments to overcome these challenges.
Several new approaches are being explored, including combination therapies that pair GLP-1 with other agents like glucagon or glucose-dependent insulinotropic polypeptide (GIP). Researchers are also investigating various ratios of these combinations to improve their effectiveness. Drugs that improve metabolism, to be used alone or in combination with appetite suppressants, is a prominent industry focus. Additionally, artificial intelligence is being used to accelerate drug discovery, and novel targets are being explored for future treatments.
As new treatments are developed, several challenges must be addressed. These include scaling up manufacturing to meet demand, improving insurance coverage for these often-expensive treatments and ensuring that new therapies aren't only effective but also safe and well-tolerated. The industry is also moving toward personalized medicine, which will require identifying the right candidates for specific therapies.
