The Obesity Drug Pipeline in 2026
Obesity drug development is expanding rapidly beyond the first generation of GLP-1 therapies. More than 1 billion people worldwide were living with obesity in 2022, including approximately 890 million adults. The clinical and commercial success of incretin-based medicines has accelerated investment across a much broader range of mechanisms, formulations and combination strategies.
The Ozmosi drug intelligence platform currently tracks more than 150 active programs across obesity and weight-related indications, spanning preclinical development through Phase 3. The competitive landscape now includes established incretin pathways alongside amylin receptor agonists, RNAi therapies targeting INHBE and ALK7, muscle-preservation approaches, CB1 antagonists and therapies for rare forms of obesity.
The market has also changed materially during 2026. Lilly’s small-molecule oral GLP-1 orforglipron, now marketed as Foundayo, received FDA approval for chronic weight management on April 1. Retatrutide has produced pivotal Phase 3 obesity results, AstraZeneca has advanced elecoglipron into Phase 3, Structure Therapeutics has begun dosing patients in its Phase 3 aleniglipron program, and Novo Nordisk’s CagriSema is under FDA review.
This analysis focuses specifically on the obesity drug-development pipeline: which mechanisms are attracting investment, which investigational assets are advancing, which companies have built the broadest portfolios, and which clinical programs could reshape the competitive landscape over the next several years.
What Does the Obesity Drug Pipeline Mean for Patients?
For patients, the most important takeaway from the rapidly expanding obesity pipeline is not simply that more drugs are being developed. It is that the next generation of obesity medicines is beginning to address some of the biggest limitations of today’s treatments: injections, gastrointestinal side effects, incomplete response, loss of lean mass and cost.
Are more effective weight-loss drugs coming?
Probably — and retatrutide is the clearest example.
Eli Lilly’s investigational retatrutide has generated enormous interest because it targets three hormone receptors — GIP, GLP-1 and glucagon — rather than one or two. In the Phase 3 TRIUMPH-1 trial, participants receiving the highest dose lost an average of 28.3% of their body weight at 80 weeks. Among participants with a starting BMI of at least 35 who continued treatment in an extension, average weight loss reached 30.3% at 104 weeks.
Those results help explain the enthusiasm around “Reta,” but patients should keep the timeline in perspective. Retatrutide is still investigational and is not currently available by prescription. Lilly says it plans to submit the obesity application to the FDA in the first quarter of 2027.
Retatrutide also does not solve every limitation of current therapy. It is still a once-weekly injection, and GLP-1 activity remains part of its mechanism. For someone whose biggest problem with current medications is inadequate weight loss, retatrutide could eventually be a major advance. For someone who cannot tolerate GLP-1-based treatment or strongly wants to avoid injections, other parts of the pipeline may be more relevant.
CagriSema could arrive sooner. Novo Nordisk submitted the combination of semaglutide and the amylin analogue cagrilintide to the FDA in December 2025 after reporting 22.7% average weight loss at 68 weeks among participants assumed to remain on treatment. It could offer another high-efficacy option, although it still contains a GLP-1 drug and is administered by injection.
What if someone does not want injections?
This problem is already becoming much easier to solve.
Two effective oral GLP-1 options for weight management are now FDA-approved in the United States. Oral Wegovy, a once-daily semaglutide tablet, was approved in December 2025. In its pivotal trial, participants who adhered to treatment lost an average of 16.6% of their body weight — similar to the efficacy seen with injectable Wegovy.
Foundayo, or orforglipron, was approved in April 2026. Unlike peptide-based oral semaglutide, it is a small-molecule GLP-1 drug and can be taken at any time of day without restrictions on food or water. Participants who remained on the highest dose in ATTAIN-1 lost an average of 12.4% of their body weight at 72 weeks.
That means patients who dislike needles no longer necessarily have to accept substantially less effective obesity treatment. Additional oral drugs, including aleniglipron, elecoglipron and oral zenagamtide, could expand that choice further if their late-stage programs are successful.
What about people who cannot tolerate GLP-1 drugs?
This may ultimately be one of the most important areas of the pipeline.
Many of the most advanced new drugs still use GLP-1 signaling, so simply switching from semaglutide to another incretin-based drug will not eliminate the possibility of nausea, vomiting, or other gastrointestinal effects. Even oral GLP-1 drugs still act on the GLP-1 receptor; changing the delivery method does not make them a different therapeutic class. Foundayo, for example, still commonly causes gastrointestinal side effects.
Amylin-based drugs offer a potentially different path.
Petrelintide is particularly interesting because it does not rely on GLP-1 receptor agonism. In Roche’s Phase 2 ZUPREME-1 trial, petrelintide produced up to 10.7% average weight loss at 42 weeks. At the maximally effective dose, Roche reported no vomiting and no treatment discontinuations caused by gastrointestinal adverse events, with overall tolerability similar to placebo.
Those are unusually encouraging results for patients who struggle with the gastrointestinal effects of current obesity drugs, although petrelintide still needs to confirm its efficacy and tolerability in Phase 3 trials before it can become a treatment option.
Other non-GLP-1 mechanisms — including RNAi therapies targeting INHBE or ALK7, CB1-targeted drugs and therapies affecting muscle and fat signaling — are further from approval. If they succeed, however, obesity treatment could eventually become much less dependent on a single drug class.
Will future drugs be better for body composition?
Potentially, and this is one of the most interesting changes happening in obesity research.
The first generation of obesity drugs has largely been judged by one number: percentage of body weight lost. Newer programs are increasingly asking a different question: what kind of weight is being lost?
Several investigational drugs are specifically designed to reduce fat while preserving lean tissue. One of the clearest early examples is Wave Life Sciences’ WVE-007, an RNAi therapy targeting INHBE. In an early Phase 1 study, a single dose produced a placebo-adjusted 14.3% reduction in visceral fat at six months while lean mass was maintained. Total body-weight reduction was modest, which illustrates how different this approach is from traditional appetite-suppressing drugs.
WVE-007 is still very early in development, so these results should not be interpreted as evidence that a muscle-preserving obesity drug is about to reach pharmacies. But the broader direction is important. Myostatin and activin inhibitors are also being studied specifically for their effects on muscle and body composition.
If these approaches work in larger trials, patients may eventually have therapies selected not just according to how many pounds they can lose, but according to visceral fat, lean-mass preservation and long-term metabolic health.
Are obesity drugs going to get cheaper?
There are finally signs of movement, although there is no reason to assume that every new drug will launch at a low price.
Competition is already affecting what some patients can pay. Foundayo’s current manufacturer self-pay program starts at $149 per month, depending on dose, while Lilly’s self-pay pricing for Zepbound starts at $299 per month. Novo Nordisk is likewise offering self-pay pricing for oral Wegovy starting at $149 per month. These programs can change and are not the same as a drug’s list price or an insured patient’s out-of-pocket cost.
Access is also changing on the insurance side. Since July 2026, eligible Medicare Part D beneficiaries have been able to obtain certain approved GLP-1 obesity medicines for $50 per month through the temporary Medicare GLP-1 Bridge program.
A much larger field of competing medicines should create more pressure on manufacturers and payers than existed when only one or two highly effective obesity drugs dominated the market. Whether that ultimately produces broadly lower prices will depend on insurance coverage, manufacturer pricing, public policy and how strongly the new drugs compete with established products.
In other words, the pipeline gives patients reason for optimism on affordability, but not yet a guarantee.
The bigger shift: obesity treatment is becoming less one-size-fits-all
The most meaningful change may ultimately be the growth in choice.
A few years ago, the major question was whether highly effective medical weight loss was possible. Increasingly, the questions are more specific: Does a patient want a pill or an injection? Do they need maximum weight loss or more modest weight loss with better tolerability? Have they responded poorly to GLP-1 therapy? Are they especially concerned about maintaining muscle? Would an infrequently administered drug make long-term treatment easier?
The current pipeline suggests that obesity treatment is moving toward a market in which those questions may actually have different answers.
Retatrutide could raise the ceiling on weight loss. Oral Wegovy and Foundayo already provide meaningful options for patients who do not want injections. Amylin therapies such as petrelintide may eventually provide alternatives for some patients who struggle with GLP-1-based treatment. RNAi and muscle-directed therapies could shift attention from total weight loss toward fat loss and lean-mass preservation.
Not all of these experimental therapies will succeed. But for consumers, the significance of a pipeline containing more than 150 active obesity programs is straightforward: the future of obesity medicine is likely to offer substantially more choice than the market patients have today.
How Do Current and Next-Generation Obesity Drugs Compare on Weight Loss?
The table below compares selected approved and late-stage obesity medicines using the highest-dose or strongest reported result in adults with obesity or overweight without type 2 diabetes, where comparable data are available.
| Drug, Maker | Status / Est. Approval | Mechanism / Format | Mean body-weight loss* | Trial duration |
|---|---|---|---|---|
| Wegovy (semaglutide), Novo Nordisk | Approved | GLP-1; weekly injection | 16.9% | 68 weeks |
| Zepbound (tirzepatide), Eli Lilly | Approved | GIP + GLP-1; weekly injection | 22.5% | 72 weeks |
| Wegovy pill (semaglutide), Novo Nordisk | Approved Dec. 2025 | GLP-1; daily oral | 16.6% | 64 weeks |
| Foundayo (orforglipron), Eli Lilly | Approved Apr. 2026 | GLP-1; daily oral small molecule | 12.4% | 72 weeks |
| CagriSema, Novo Nordisk | FDA review · est. 2026 | Amylin + GLP-1; weekly injection | 22.7% | 68 weeks |
| Retatrutide, Eli Lilly | Phase 3 · est. Dec. 2027 | GIP + GLP-1 + glucagon; weekly injection | 28.3% | 80 weeks |
| Enicepatide (CT-388), Roche | Phase 3 · est. Jul. 2030 | GIP + GLP-1; weekly injection | 22.5%‡ | 48 weeks |
| MariTide (maridebart cafraglutide), Amgen | Phase 3 · est. May 2028 | GLP-1 agonist + GIPR antagonist; monthly or less frequent injection | ~20% | 52 weeks |
| Eloralintide, Eli Lilly | Phase 3 · est. Feb. 2031 | Amylin; weekly injection | 20.1% | 48 weeks |
| Survodutide, Boehringer Ingelheim / Zealand Pharma | Phase 3 · est. Feb. 2031 | GLP-1 + glucagon; weekly injection | 16.6% | 76 weeks |
| Aleniglipron, Structure Therapeutics | Phase 3 · Est. approval TBD | GLP-1; daily oral small molecule | 15.3% | 44 weeks |
| Elecoglipron, AstraZeneca | Phase 3 · est. Jul. 2031 | GLP-1; daily oral small molecule | 11.8% | 36 weeks |
| Zenagamtide (formerly amycretin), Novo Nordisk | Phase 3 · est. Oct. 2029 | GLP-1 + amylin; oral and injectable programs | 24.3%¹ | 36 weeks |
| Petrelintide, Roche / Zealand Pharma | Phase 2 → Phase 3 planned · est. Apr. 2031 | Amylin; weekly injection | 10.7% | 42 weeks |
* Important: These are cross-trial comparisons, not head-to-head results. Trial populations, durations, doses, titration schedules, and statistical estimands differ. The figures are useful for understanding the emerging efficacy range, but they should not be interpreted as a definitive ranking of the drugs.
‡ Enicepatide: Roche reports 22.5% placebo-adjusted weight loss at 48 weeks, not an unadjusted 22.5% treatment-group mean.
¹ Zenagamtide: The 24.3% result is from an earlier Phase 1b/2a obesity study of once-weekly subcutaneous zenagamtide at 60 mg, not from the current Phase 3 trials. Novo’s AMAZE Phase 3 obesity program is now underway.
Part I: Major Targets in the Obesity Drug Pipeline
1. GLP-1 and Multi-Agonist Obesity Drugs
GLP-1 receptor agonism remains the foundation of obesity drug development, but the competitive question has changed. With injectable and oral GLP-1 therapies now established in the market, development is increasingly focused on greater efficacy, less frequent dosing, oral delivery, improved tolerability, and therapies that engage multiple metabolic pathways.
Lilly’s orforglipron illustrates how quickly that transition is occurring. The once-daily small-molecule GLP-1 is no longer a pipeline asset in the United States: the FDA approved Foundayo in April 2026 for chronic weight management in adults with obesity or qualifying overweight. Its approval creates an important commercial and clinical benchmark for oral GLP-1 candidates still in development.
Retatrutide remains one of the most closely watched investigational drugs in the field. Lilly’s triple GIP/GLP-1/glucagon receptor agonist has now reported pivotal Phase 3 results from multiple TRIUMPH studies. In TRIUMPH-1, Lilly reported average weight loss of 28.3% at 80 weeks with the 12 mg dose under the efficacy estimand. Additional Phase 3 results reported in July extended the program into participants with type 2 diabetes and established cardiovascular disease.
Novo Nordisk’s CagriSema combines the amylin analogue cagrilintide with semaglutide. The company reported 22.7% mean weight loss at 68 weeks in REDEFINE 1 among participants assumed to adhere to treatment and submitted CagriSema to the FDA for weight management in December 2025.
The next generation of oral small molecules is also advancing quickly. AstraZeneca moved elecoglipron into Phase 3 after reporting Phase 2b VISTA data in June 2026; six Phase 3 trials had been initiated by the company’s July pipeline update. Structure Therapeutics dosed the first patients in the Phase 3 ACCOMPLISH program for aleniglipron in the third quarter of 2026.
Novo Nordisk is advancing zenagamtide, formerly known as amycretin, as a unimolecular GLP-1 and amylin receptor agonist. Both oral and subcutaneous approaches are being developed, with Phase 3 evaluation underway. Amycretin and zenagamtide are names for the same development program and should not be counted as separate pipeline assets.
Beyond traditional GLP-1 agonism, Amgen’s maridebart cafraglutide, or MariTide, combines GLP-1 receptor agonism with GIP receptor antagonism and is now being evaluated in the Phase 3 MARITIME program. Roche has moved its dual GLP-1/GIP agonist enicepatide, formerly CT-388, into Phase 3, while Boehringer Ingelheim has reported Phase 3 results for the GLP-1/glucagon dual agonist survodutide.
The GLP-1 segment is therefore becoming less a contest over whether incretin therapy works and more a competition over product profile: efficacy, tolerability, route of administration, dosing frequency, body composition and performance across obesity-related comorbidities.
For a deeper discussion of approved GLP-1 therapies, oral formulations and the commercial market, see Ozmosi’s existing GLP-1 Agonists and the Obesity Market overview.
2. Amylin Analogues and GLP-1/Amylin Combinations
Amylin has become one of the most important complementary mechanisms in obesity drug development. The pancreatic hormone contributes to satiety through pathways distinct from GLP-1 signaling, creating opportunities for both stand-alone amylin therapies and combinations with incretin drugs.
Eloralintide is Lilly’s selective, long-acting amylin receptor agonist. The program has moved into Phase 3, including the ENLIGHTEN-1 study in adults with obesity or overweight without type 2 diabetes and ENLIGHTEN-2 in participants with type 2 diabetes. Lilly is also evaluating eloralintide in people with persistent obesity already receiving incretin therapy.
Petrelintide, developed through a collaboration between Zealand Pharma and Roche, has also advanced substantially. Roche reported positive Phase 2 ZUPREME-1 results in March 2026, including up to 10.7% mean weight reduction at week 42. Roche subsequently announced that petrelintide is moving into Phase 3 development and is also being evaluated as a combination partner with enicepatide.
AstraZeneca’s AZD6234 is a once-weekly selective amylin receptor agonist currently in Phase 2 for chronic weight management. The company is also studying AZD6234 in combination with its GLP-1/glucagon agonist AZD9550.
CagriSema represents the most advanced amylin/GLP-1 combination currently in regulatory development in the United States. Zenagamtide takes a different approach by combining GLP-1 and amylin receptor activity in a single molecule rather than co-formulating two separate drugs.
Structure Therapeutics is pursuing yet another route: oral small-molecule amylin agonism. ACCG-2671 entered Phase 1 in late 2025 and remains in an ongoing first-in-human study, with initial clinical data expected in 2026.
Pfizer’s amylin strategy includes PF-08653945, formerly MET-233i, which is being developed both independently and in combination with the company’s long-acting GLP-1 agonist berobenatide. AbbVie has also entered the field with ABBV-295, formerly GUB014295, a long-acting amylin analogue licensed from Gubra. AbbVie reported positive Phase 1 multiple-ascending-dose results in March 2026.
Amylin is therefore no longer a niche adjunct to the incretin market. It is being pursued as monotherapy, in fixed combinations, in unimolecular dual agonists and through oral small molecules.
3. INHBE and ALK7: RNAi and Genetically Informed Obesity Therapies
One of the most scientifically distinct areas of the current pipeline targets the INHBE/ALK7 pathway. Human genetic data have associated reduced activity in this pathway with favorable patterns of adiposity and metabolic risk, creating interest in therapies designed to alter fat mass and distribution without relying primarily on appetite suppression.
Arrowhead Pharmaceuticals is developing two RNAi candidates in this pathway: ARO-INHBE and ARO-ALK7. Both remain in Phase 1/2a development rather than Phase 2, as some earlier pipeline summaries have described them. Arrowhead reported additional clinical data from ARO-INHBE during 2026 and has submitted a Phase 2b protocol to regulators as it plans the program’s next stage.
Wave Life Sciences has progressed WVE-007, an INHBE-targeting GalNAc-siRNA, into the Phase 2a portion of its INLIGHT study. Wave reported that Phase 1 data showed reductions in visceral and total body fat while lean mass was maintained or increased, supporting continued evaluation in obesity and cardiometabolic disease.
Alnylam is also building an adipose-targeted RNAi franchise. ALN-2232, which targets ACVR1C/ALK7, entered Phase 1 in 2026, while ALN-6222 targets INHBE. Separately, ALN-4324 targets GRB14 and is being evaluated in Phase 2 for type 2 diabetes as a potential insulin-sensitizing therapy.
These programs are earlier than the major incretin and amylin assets, but they address a different strategic question: whether future obesity treatment can selectively improve fat mass and metabolic health while preserving lean tissue. The next several clinical readouts should provide much clearer evidence about whether that hypothesis translates from human genetics and early trials into clinically meaningful weight management.
4. Myostatin and Activin Inhibitors: Targeting Body Composition
A related group of programs targets myostatin and activin signaling, pathways involved in the regulation of muscle mass.
Interest in these mechanisms has increased as body composition becomes a more important consideration in obesity treatment. Weight loss from pharmacotherapy includes both fat and lean tissue, creating a potential role for adjunctive drugs designed to preserve or increase muscle while reducing fat mass.
Bimagrumab, acquired by Lilly through its purchase of Versanis, blocks activin type II receptors. Lilly continues to evaluate bimagrumab in Phase 2 obesity studies, both alone and in combination with incretin therapy.
Roche is evaluating the anti-myostatin antibody emugrobart in obesity through the Phase 2 GYMINDA study in combination with tirzepatide. Roche’s current development materials continue to list a 2026 Phase 2 readout for that program.
Several additional activin and myostatin programs remain in earlier clinical development. For this class, the key commercial question is unlikely to be weight loss alone. The differentiating evidence will be whether these therapies can materially improve the quality of weight loss, functional outcomes or long-term weight maintenance when paired with established obesity drugs.
5. CB1 Antagonists: Revisiting an Earlier Obesity Target
Cannabinoid receptor 1 inhibition has returned to obesity drug development after the first generation of CB1-directed therapies was abandoned because of neuropsychiatric adverse events.
The current strategy is to restrict drug activity largely to peripheral tissues, with the goal of retaining metabolic effects while limiting central nervous system exposure.
Novo Nordisk completed a Phase 2a obesity study of monlunabant, formerly INV-202. Its current public pipeline emphasizes continued Phase 2 development in diabetic kidney disease rather than listing a new active obesity trial, so monlunabant should not be described as an ongoing Phase 2 obesity program without qualification.
Corbus Pharmaceuticals is advancing CRB-913, a highly peripherally restricted oral CB1 inverse agonist. Its 240-participant CANYON-1 Phase 1b obesity study completed its final patient visit in August 2026, with topline results expected in September.
Nimacimab is also being evaluated clinically in obesity. Together, these programs will help determine whether peripheral restriction can successfully revive CB1 as a viable weight-management mechanism.
6. MC4R Agonists for Rare and Hypothalamic Obesity
MC4R-directed therapies occupy a smaller but clinically important segment of the obesity landscape because they target specific biological causes of severe obesity rather than the broad common-obesity market.
Setmelanotide, marketed as Imcivree, is already approved for several rare genetic obesity disorders. In March 2026, the FDA expanded its use to acquired hypothalamic obesity in adults and children four years of age and older.
Rhythm Pharmaceuticals continues to develop next-generation MC4R agonists, including the oral candidate bivamelagon and weekly injectable RM-718. Bivamelagon has generated Phase 2 data in acquired hypothalamic obesity, while RM-718 remains in earlier clinical development.
This is not a volume market comparable with common obesity, but it remains an important example of increasingly mechanism-specific obesity drug development.
Part II: Which Companies Have the Broadest Obesity Pipelines?
The competitive landscape is no longer defined simply by which companies have a GLP-1 agonist. The largest portfolios increasingly span oral and injectable incretins, amylin, body-composition therapies and other non-incretin mechanisms.
Eli Lilly
Lilly continues to have one of the broadest obesity portfolios in the industry.
Its commercial position now includes tirzepatide and the newly approved oral GLP-1 Foundayo. Its late-stage pipeline includes retatrutide and Phase 3 eloralintide, while bimagrumab provides a non-incretin body-composition strategy. Retatrutide’s 2026 Phase 3 readouts further strengthen Lilly’s position at the high-efficacy end of the market.
The distinguishing feature is not any single asset but the number of different ways Lilly can potentially combine, sequence or differentiate therapies across obesity and related cardiometabolic conditions.
Novo Nordisk
Novo Nordisk’s pipeline is increasingly centered on extending its established incretin franchise into the amylin and combination era.
CagriSema has already been submitted to the FDA for weight management. Cagrilintide continues to give Novo a stand-alone amylin platform as well as a combination component, while zenagamtide—formerly known as amycretin (NNC0487-0111)—is advancing through Phase 3 as a unimolecular GLP-1/amylin receptor agonist.
Pfizer
Pfizer has rebuilt its obesity strategy substantially through business development, particularly its acquisition of Metsera.
Berobenatide, formerly MET-097i and now PF-08653944, has moved into an extensive Phase 3 program evaluating weekly and monthly dosing as well as obesity-related comorbidities. Pfizer has said it plans more than 20 obesity trials during 2026, including 10 ongoing or planned Phase 3 studies for berobenatide.
Its broader portfolio includes the amylin analogue PF-08653945 and additional GIP and oral programs, giving Pfizer multiple potential combination strategies rather than a single-asset obesity bet.
Roche
Roche has built one of the fastest-expanding obesity portfolios through acquisition and collaboration.
Enicepatide, previously CT-388, is now in an ongoing Phase 3 program. Petrelintide is moving into Phase 3 after positive Phase 2 results, and Roche is also studying a fixed-dose combination of the two. Its once-daily oral GLP-1 candidate CT-996 remains in clinical development, while emugrobart adds a body-composition strategy through myostatin inhibition.
The portfolio is notable for its deliberate combination architecture: Roche is developing assets that can compete independently but also serve as building blocks for future multi-mechanism regimens.
AstraZeneca
AstraZeneca has rapidly developed a multimodal weight-management pipeline spanning oral GLP-1 therapy, amylin and additional peptide mechanisms.
Elecoglipron is now in Phase 3 for weight management. AZD6234 remains in Phase 2, AZD1043 is in Phase 1, and the AZD6234/AZD9550 combination is being evaluated in Phase 2. AstraZeneca has also expanded its discovery portfolio through external licensing deals.
This gives the company exposure to both the highly competitive oral GLP-1 market and the emerging non-GLP-1 combination landscape.
Amgen
Amgen’s obesity strategy is more concentrated, but its lead program is highly differentiated.
MariTide combines GLP-1 receptor agonism with GIP receptor antagonism and is being evaluated in the Phase 3 MARITIME program across obesity and obesity-related conditions.
Its less-frequent dosing profile and distinct mechanism make MariTide an important test of whether the next generation of obesity products can differentiate not only through weight loss but also through treatment frequency and durability.
Boehringer Ingelheim
Boehringer Ingelheim’s lead obesity asset, survodutide, combines GLP-1 and glucagon receptor agonism.
The company reported positive Phase 3 SYNCHRONIZE results in 2026, including significant weight reduction and additional body-composition and metabolic findings.
Survodutide is particularly relevant to the growing competition among multi-agonist drugs that attempt to move beyond GLP-1-only mechanisms.
RNAi Specialists: Arrowhead, Wave and Alnylam
RNA-based obesity development is being driven by a different group of companies.
Arrowhead is simultaneously developing ARO-INHBE and ARO-ALK7. Wave has moved WVE-007 into Phase 2a, and Alnylam has brought its first adipose-targeted RNAi therapy, ALN-2232, into the clinic.
These companies are earlier in development than the large incretin competitors, but their programs could establish an entirely different therapeutic category if clinical studies confirm meaningful fat reduction with preservation of lean mass.
Structure Therapeutics
Structure Therapeutics is building its obesity strategy around oral small molecules.
Aleniglipron has now entered Phase 3, while ACCG-2671 provides an early clinical foothold in oral amylin receptor agonism. The company is also developing a second oral amylin candidate, ACCG-3535.
The strategic attraction is clear: if oral small molecules can approach the efficacy of injectable peptide therapies while simplifying manufacturing and administration, they could occupy a significant part of a much larger obesity-treatment market.
Rhythm Pharmaceuticals and AbbVie
Two additional companies illustrate how widely obesity development is spreading beyond the incumbent leaders.
Rhythm remains focused on rare and hypothalamic obesity through setmelanotide and next-generation MC4R agonists. The 2026 FDA approval of setmelanotide for acquired hypothalamic obesity expanded the company’s commercial footprint while bivamelagon and RM-718 continue development.
AbbVie entered obesity through its licensing agreement with Gubra for ABBV-295. Positive Phase 1 data reported in March 2026 support continued development of the long-acting amylin analogue and give AbbVie a non-incretin entry point into the field.
Part III: What the Competitive Landscape Looks Like Now
Several themes stand out when the current obesity pipeline is viewed across mechanisms rather than drug by drug.
First, oral therapy is now a commercial reality rather than a future possibility. Foundayo’s FDA approval changes the benchmark for oral development, while elecoglipron and aleniglipron are advancing through late-stage programs.
Second, amylin has become a major competitive axis. Lilly, Novo Nordisk, Roche, AstraZeneca, Pfizer, AbbVie and Structure Therapeutics are now pursuing amylin through peptides, combinations, dual agonists or oral small molecules.
Third, the pipeline is moving beyond appetite suppression. RNAi programs targeting INHBE and ALK7 and antibody programs targeting activin or myostatin reflect increasing emphasis on body composition, fat distribution and lean-mass preservation.
Fourth, combination development is becoming a portfolio strategy rather than a single-product strategy. Roche is pairing enicepatide with petrelintide; Pfizer is building around a long-acting GLP-1 backbone with amylin and other partners; Novo is combining semaglutide and cagrilintide while also developing a unimolecular GLP-1/amylin agonist; and Lilly is evaluating complementary mechanisms around an already broad incretin franchise.
Finally, development activity is increasingly global. Ozmosi’s database identifies a substantial group of late-stage or partnered obesity assets originating from Chinese pharmaceutical companies, adding another source of competitive pressure to a market that is already unusually crowded.
Major Obesity Drug Readouts to Watch
The 2026–2028 period remains an unusually dense development window, but the most useful way to follow it is no longer a static list of projected primary completion dates. Trial timelines move, programs expand, regulatory submissions occur earlier than expected, and—as orforglipron demonstrated in 2026—approval timing can shift substantially.
The highest-value developments to monitor include:
- Additional Phase 3 retatrutide results and the program’s regulatory path.
- The FDA review and potential regulatory outcome for CagriSema.
- Phase 3 development of elecoglipron and aleniglipron in the increasingly competitive oral market.
- Phase 3 progress for enicepatide, petrelintide, MariTide, survodutide and eloralintide.
- Clinical validation of INHBE/ALK7 therapies from Wave, Arrowhead and Alnylam.
- Evidence that myostatin or activin-directed combinations can meaningfully improve body composition.
- Phase 1b results from CRB-913 and the broader viability of peripherally restricted CB1 inhibition.
Pharma Companies With Limited Obesity Exposure
Ozmosi’s current database also identifies several large pharmaceutical companies with little or no clearly material obesity pipeline relative to the companies above.
The original analysis included Johnson & Johnson, Bristol Myers Squibb, Biogen, Moderna, Vertex, Takeda, Bayer, UCB and Astellas among the most notable examples. Because early discovery programs, licensing transactions and internal portfolio decisions can change quickly, this group is best treated as a point-in-time database observation rather than a permanent list of companies “sitting out” obesity.
GSK, AbbVie and Novartis should not be grouped with true holdouts. Each has entered the broader obesity or metabolic-development landscape, although their programs remain earlier or more limited than those of Lilly, Novo Nordisk, Roche, Pfizer and AstraZeneca.
Key Takeaways
- The obesity pipeline is no longer synonymous with the GLP-1 pipeline. Incretins remain central, but amylin, RNAi, body-composition therapies, CB1 antagonists and mechanism-specific rare-obesity drugs are creating distinct areas of competition.
- Oral GLP-1 development has entered a new phase. The first small-molecule oral GLP-1 for chronic weight management is now approved in the United States, meaning investigational oral programs must compete against a commercial benchmark rather than an unmet hypothetical need.
- Amylin has moved firmly into the mainstream. Multiple large pharmaceutical companies are now pursuing stand-alone amylin therapies, GLP-1/amylin combinations and dual agonists.
- The quality of weight loss is becoming a development target. RNAi, myostatin and activin programs reflect increasing interest in visceral fat reduction and lean-mass preservation alongside total body-weight reduction.
- Lilly currently has exceptional breadth across obesity mechanisms, but Novo Nordisk, Roche, Pfizer and AstraZeneca have all built increasingly diversified portfolios. Competitive leadership will depend on more than maximum weight loss alone.
- Combination therapy is likely to become increasingly important. Many of the largest companies are assembling portfolios in which individual assets can be developed both as monotherapies and as components of multi-mechanism regimens.
- The field is moving too quickly for static pipeline assumptions to remain current for long. Regulatory approvals, renamed assets, acquisitions and accelerated development programs can materially alter competitive analysis within months.
Methodology and Data Note
This analysis is based on the Ozmosi drug intelligence platform, which brings together structured pharmaceutical R&D data across clinical registries, regulatory filings, scientific literature, company disclosures and industry announcements.
Ozmosi tracks more than 800,000 clinical trials, 35,000 drugs and 4,000 diseases and conditions through a standardized taxonomy connecting assets, mechanisms, indications, companies and development stages. That structure enables market-level analysis across programs that are otherwise dispersed among individual registries and company pipelines.
Publicly reported phase and regulatory statuses in this article were additionally reviewed against current sponsor and regulatory sources through August 2026.
Clinical trial timelines and development stages can change, and investigational therapies may be delayed, discontinued, or advanced. Any projected approval timing generated from trial primary completion dates and historical development benchmarks should be treated as model-based analysis rather than a definitive regulatory timeline.
