Pipeline by Mechanism and Stage

All material GLP-1 and adjacent obesity assets as of May 2026 plotted by mechanism family (Y axis) and development stage (X axis). Bubble size scales with reported placebo-adjusted weight loss. The visual mechanism diversity is the structural pipeline story: triple agonists, dual GLP-1/GIP, dual GLP-1/glucagon, amylin combos, oral non-peptide, MC4R, CB1, FGF21, and antibody-peptide conjugates all in development simultaneously.

GLP-1 (mono)Oral GLP-1Oral non-peptide GLP-1Dual GLP-1/GIPDual GLP-1/glucagonTriple (GLP-1/GIP/glucagon)Amylin mono or comboAntibody-peptide conjugateMC4R agonistCB1 antagonistFGF21 analog (MASH-adjacent)

All material GLP-1 and adjacent obesity assets as of May 2026, organized by mechanism family (Y axis) and development stage (X axis). Bubble size scales with reported placebo-adjusted weight loss percentage; bubble color reflects mechanism family. Approved assets sit at stage 4 (Wegovy, Zepbound, Mounjaro, Ozempic, Mazdutide, Ecnoglutide, Rybelsus, IMCIVREE). Triple agonists (retatrutide) and Roche CT-388 have the highest weight loss in Phase 3.

Injectable Pipeline: Weight Loss vs Trial Duration

Placebo-adjusted weight loss percentage versus trial duration for injectable obesity candidates, color-coded by mechanism. Triple agonists (retatrutide), Roche CT-388, and Novo amycretin anchor the upper-right max-efficacy quadrant. Tirzepatide at 72 weeks sets the approved-asset benchmark. Shorter-duration trials may understate steady-state efficacy.

Triple (GLP-1/GIP/glucagon)Dual GLP-1/GIPAmylin + GLP-1 comboDual GLP-1/glucagonAntibody-peptide conjugateGLP-1Amylin monoAmylin + GLP-1 co-agonist

Placebo-adjusted weight loss percentage versus trial duration. The upper-right corner of the chart reads "maximum efficacy"; triple agonists (retatrutide), Roche CT-388, and amycretin (Novo) anchor that quadrant. Tirzepatide 15mg at 72 weeks (SURMOUNT-1) sets the approved-asset benchmark at 17.8%. VK2735 injectable at just 13 weeks already shows 13.1% efficacy, suggesting strong steady-state potential. Trial durations vary; shorter trials may understate maximum efficacy at steady state.

Oral GLP-1 and Adjacent Oral Candidates

Oral GLP-1 RAs and adjacent oral mechanism candidates ranked by stage. Orforglipron (Lilly) is the most differentiated: first oral non-peptide GLP-1 RA, which removes the SNAC absorption-enhancer requirement. Aleniglipron (Structure + Roche) and VK2735 oral (Viking) are the lead small-cap orals. Bivamelagon (Rhythm) is the oral MC4R adjacency.

Drug	Sponsor	Mechanism	Formulation	Weight loss	Duration	Stage	Status
Rybelsus (oral semaglutide)	Novo Nordisk	GLP-1	Daily oral peptide + SNAC absorption enhancer	4.0%	26-68 wk	Approved	T2D since 2019; oral Wegovy obesity launched Jan 2026
Orforglipron	Eli Lilly	Non-peptide GLP-1	Daily oral small molecule (no absorption enhancer required)	9.1%	72 wk	FDA decision Q2 2026	First oral non-peptide GLP-1 RA. ATTAIN-1 readout late 2025
Aleniglipron	Structure + Roche	GLP-1	Oral small molecule (with Roche licensing partner)	11.0%	36 wk	Phase 2 (Phase 3 planned)	Two positive Phase 2 readouts; high-dose 11%+ placebo-adjusted
VK2735 (oral)	Viking	Dual GLP-1/GIP	Daily oral	10.9%	13 wk	Phase 2 hit (Phase 3 planned)	VENTURE-Oral Ph2 mid-stage data; injectable VK2735 ahead in Phase 3
ECC5004	AstraZeneca	GLP-1	Oral small molecule	7.0%	16 wk	Phase 2	Building third-tier oral franchise
TERN-601	Terns	GLP-1	Oral small molecule	5.0%	12 wk	Phase 2	MASH and obesity combination strategy
K-757 / KAL-1199	Kallyope	GLP-1	Oral peptide (gut-restricted)	4.0%	12 wk	Phase 2	Gut-restricted approach minimizes systemic exposure
ARD-101	Aardvark	Bitter receptor agonist	Oral	3.0%	12 wk	Phase 2	Prader-Willi syndrome and obesity adjacencies
Bivamelagon	Rhythm	Oral MC4R agonist	Oral small molecule	7.0%	14 wk	Phase 2	Phase 2 BMI reduction comparable to IMCIVREE (setmelanotide)

Oral GLP-1 and adjacent oral mechanism candidates ranked by stage. Orforglipron (Lilly) is the most differentiated candidate as the first oral non-peptide GLP-1 RA, which removes the requirement for absorption enhancers like SNAC. Oral peptides (Rybelsus, oral Wegovy) require SNAC permeation enhancer technology. The oral route faces vs-injectable bioavailability and convenience tradeoffs but addresses patient preference for pill-based dosing.

Long-Acting and Differentiated Dosing

Candidates targeting dosing intervals beyond the once-weekly standard. MariTide (Amgen) is the only Phase 3 candidate; the rest are preclinical or undisclosed early-clinical work. Long-acting dosing is the most credible adherence lever against the ~two-thirds first-year discontinuation rate Munich Re tracks across 41M insured lives.

Drug	Sponsor	Mechanism	Dosing interval	Stage	Rationale
MariTide	Amgen	Antibody-peptide conjugate (GLP-1 agonist + GIPR antagonist)	Monthly or less frequent	Phase 3	Conjugate chemistry from oncology ADC playbook enables extended half-life
MariTide Q-monthly variants	Amgen	Antibody-peptide conjugate	Q-monthly investigational	Phase 1	Conjugate design supports further interval extension if safety holds
Tirzepatide depot (exploratory)	Eli Lilly	Dual GLP-1/GIP (peptide depot)	Bi-weekly or monthly target	Preclinical / undisclosed	Existing tirzepatide molecule reformulated for longer release
Long-acting semaglutide	Novo Nordisk	Extended half-life GLP-1	Bi-weekly to monthly target	Preclinical	Same semaglutide active with engineered half-life extension
TransCon GLP-1 (exploratory)	Ascendis Pharma	TransCon prodrug platform	Weekly to monthly target	Preclinical	Sustained-release platform validated in growth hormone (Skytrofa)

Candidates targeting dosing intervals beyond the once-weekly standard (semaglutide, tirzepatide). MariTide is the only Phase 3 candidate; the rest are preclinical or undisclosed early-clinical work at Lilly, Novo, and platform-specialist Ascendis. Long-acting dosing is the most credible adherence lever against the ~two-thirds first-year discontinuation rate Munich Re tracks across 41M insured lives. Investor patience required: the upside takes years of trial reads to materialize.

Late-Stage Phase 3 Readouts

Phase 3 readouts through 2028 mapped by company, mechanism, indication, and target window. The catalyst calendar that drives pipeline-tab valuation moves: retatrutide TRIUMPH, MariTide late 2026, survodutide 2026 to 2027, amycretin 2027, VK2735 injectable 2027, aleniglipron 2027.

Readout	Company	Asset	Mechanism	Indication	Trial	Note
2026-Q2	Eli Lilly(LLY)	Orforglipron	Oral non-peptide GLP-1	Obesity	ATTAIN program	First oral non-peptide GLP-1 RA. ATTAIN-1 reported 11.2% mean weight loss at 72 weeks (high dose) vs 2.1% placebo. FDA decision Q2 2026.
2026-H1	Eli Lilly(LLY)	Tirzepatide	Dual GLP-1/GIP	MACE in T2D	SURPASS-CVOT readout context	Label expansion for cardiovascular outcomes in T2D expected H1 2026. Triggers Medicare Part D coverage for tirzepatide CV indication.
2026-H2	Novo Nordisk(NVO)	CagriSema	Amylin + GLP-1 combo	Obesity	REDEFINE-1	Cagrilintide 2.4mg + semaglutide 2.4mg, once-weekly injection. 68-week Phase 3a (NEJM): ~22.7% mean weight loss. Filed December 2025.
2026	Altimmune(ALT)	Pemvidutide	GLP-1 / glucagon dual	MASH (pivotal)	IMPACT	MASH-first positioning. Pivotal MASH IMPACT data expected 2026.
2026-late	Amgen(AMGN)	MariTide	Antibody-peptide conjugate (GLP-1 agonist + GIPR antagonist)	Obesity	MARITIME program	Monthly or less frequent dosing. Phase 3 readout expected late 2026, BLA filing late 2026 to early 2027.
2026-2027	Roche(RHHBY)	CT-388	Dual GLP-1/GIP	Obesity	Phase 3 (initiating)	Carmot acquisition asset. Phase 2: ~23% placebo-adjusted weight loss at 48 weeks. Phase 3 initiating in 2026.
2026-2027	Boehringer + Zealand(ZEAL.CO)	Survodutide	GLP-1 / glucagon dual	MASH and obesity	SYNCHRONIZE program	Partnered with Boehringer Ingelheim (private). MASH and obesity readouts 2026 to 2027.
2026-2027	Eli Lilly(LLY)	Retatrutide	Triple GLP-1/GIP/glucagon	Obesity, T2D, MASH	TRIUMPH program	First triple agonist in Phase 3. Phase 2 weight loss approaching 24-26%, comparable to bariatric surgery. Multiple TRIUMPH trials reading out 2026 to 2027.
2026	AstraZeneca(AZN)	AZD6234	Oral amylin agonist	Obesity	APRICUS Phase 2b	Phase 2b completing 2026. Amylin pathway differentiation for GLP-1-intolerant patients or as combination partner.
2027	Novo Nordisk(NVO)	Amycretin	GLP-1 + amylin co-agonist	Obesity	Phase 3	Next-generation Novo asset. Phase 1 readouts very encouraging; Phase 3 starting 2026, readouts expected 2027.
2027	Viking Therapeutics(VKTX)	VK2735 (injectable)	Dual GLP-1/GIP	Obesity	VANQUISH-1 Phase 3	Phase 2 injectable hit obesity endpoint; Phase 3 ongoing. M&A-prone given big-pharma demand.
2027	Structure Therapeutics(GPCR)	Aleniglipron	Oral small-molecule GLP-1	Obesity and T2D	ACCESS-3 and ACCESS-T2D	Roche licensing partnership ($100M) for additional assets. Phase 2 high-dose 11%+ placebo-adjusted at 36 weeks.
2027-2028	Akero(AKRO)	Efruxifermin	FGF21 analog	MASH	SYMMETRY	MASH-adjacent (non-GLP-1). Novo Nordisk acquiring Akero for $5.2B; positions MASH as combinable with GLP-1.

Phase 3 readouts for GLP-1 and adjacent obesity assets through 2028. Mechanism diversification is the structural pipeline story: triple agonists (retatrutide), amylin combinations (CagriSema, amycretin, MariTide), monthly biologics (MariTide), oral non-peptide (orforglipron), and MASH-first (pemvidutide, efruxifermin). Readout windows reflect company guidance and ClinicalTrials.gov estimates; subject to revision quarter to quarter.

FDA Decision Calendar

Anticipated FDA approval, label expansion, and rulemaking decisions through 2027. Past decisions (Wegovy CV March 2024, Zepbound OSA December 2024, semaglutide CKD January 2025, IMCIVREE acquired hypothalamic obesity March 2026) included for context. The April 2026 503A bulk substances proposal closes for comment June 29, 2026; semaglutide IRA-negotiated price takes effect January 2027; CMS GLP-1 Bridge program launches July 1, 2026.

Expected	Company	Asset	Indication	Type	Status	Note
2024-03	Novo Nordisk(NVO)	Wegovy (semaglutide 2.4mg)	MACE risk reduction in CVD + overweight/obesity	Label Expansion	Approved	SELECT trial: 20% MACE reduction. Triggered Medicare Part D coverage for cardiovascular indication.
2024-12	Eli Lilly(LLY)	Zepbound (tirzepatide)	Moderate-to-severe OSA in obesity	Label Expansion	Approved	SURMOUNT-OSA trial. Opened sleep medicine and pulmonology prescriber base.
2025-01	Novo Nordisk(NVO)	Ozempic (semaglutide 1mg)	Chronic kidney disease in T2D	Label Expansion	Approved	FLOW trial: 24% reduction in composite kidney endpoint.
2026-03	Rhythm(RYTM)	IMCIVREE (setmelanotide)	Acquired hypothalamic obesity	Label Expansion	Approved	First FDA-approved therapy for acquired hypothalamic obesity. MC4R agonist, narrow indication.
2026-Q2	Eli Lilly(LLY)	Orforglipron	Chronic weight management	New Drug Approval	PDUFA pending	First oral non-peptide GLP-1 receptor agonist. ATTAIN-1: 11.2% mean weight loss at 72 weeks vs 2.1% placebo.
2026-H1	Eli Lilly(LLY)	Mounjaro (tirzepatide)	MACE risk reduction in T2D	Label Expansion	Expected	Lilly guidance H1 2026. Triggers Medicare Part D coverage for tirzepatide CV indication.
2026-06-29	FDA	503A bulk substances proposal	Compounding crackdown	Rulemaking	Comment open	Public comment closes June 29, 2026 on proposal to remove semaglutide, tirzepatide, liraglutide from 503A bulk list. Effectively ends large-scale compounding.
2026-07-01	CMS	Medicare GLP-1 Bridge	Access program launch	Coverage Program	Scheduled	$50/month copay for eligible Medicare beneficiaries with covered cardiovascular indication. Runs through December 31, 2027.
2026-H2	Novo Nordisk(NVO)	Semaglutide	MASH	Label Expansion	Filed (sNDA)	ESSENCE Phase 3 published 2025. FDA decision date to verify; expected 2026 to 2027.
2026-H2	Novo Nordisk(NVO)	CagriSema (cagrilintide + semaglutide)	Chronic weight management	New Drug Approval	Filed (Dec 2025)	Once-weekly injection combining amylin + GLP-1. 68-week Phase 3a NEJM: about 22.7% mean weight loss.
2026-Q4	Eli Lilly(LLY)	Zepbound (tirzepatide)	Adolescent obesity (12 to 17)	Label Expansion	Late-stage	Late-stage adolescent trials reading out 2026. Wegovy is the only currently-approved adolescent option.
2026-2027	Roche(RHHBY)	CT-388	Chronic weight management	Phase 3 advance	Phase 3 start 2026	Carmot-origin dual GLP-1/GIP. Phase 2 showed about 23% placebo-adjusted weight loss at 48 weeks.
2026-late	Amgen(AMGN)	MariTide	Chronic weight management	Phase 3 readout	Phase 3 ongoing	Differentiated antibody-peptide conjugate, monthly or less frequent dosing. BLA filing late 2026 to early 2027.
2026	Altimmune(ALT)	Pemvidutide	MASH (IMPACT pivotal)	Phase 3 readout	Pivotal data 2026	GLP-1/glucagon dual agonist. MASH-first positioning differentiates from obesity-focused peers.
2027-01-01	CMS	Semaglutide (Ozempic, Wegovy, Rybelsus)	IRA negotiated price effective	Pricing	Scheduled	IRA Medicare Drug Price Negotiation maximum fair price takes effect Jan 1, 2027.
2027-late	Boehringer + Zealand(ZEAL.CO)	Survodutide	MASH and obesity	Phase 3 readout	Phase 3 ongoing	Dual GLP-1/glucagon partnered with Boehringer Ingelheim (private). MASH and obesity readouts expected 2026 to 2027.

Anticipated FDA approval, label expansion, and rulemaking decisions for GLP-1 and adjacent obesity assets through 2027. Past decisions (Wegovy CV March 2024, Zepbound OSA December 2024, semaglutide CKD January 2025, IMCIVREE acquired hypothalamic obesity March 2026) included for context. Dates reflect company guidance and PDUFA where disclosed; otherwise expected-window estimates. Verify quarterly against FDA Drugs@FDA and company filings.