Lilly lays out four-molecule obesity pipeline at ADA, led by tirzepatide and orforglipron
Lilly says it wants a broad set of obesity medicines because one drug will not fit all patients, and its oral option orforglipron now has US approval for weight management.
At the American Diabetes Association's 86th Scientific Sessions on June 6, 2026, Eli Lilly executives laid out a cardiometabolic portfolio built around four medicines — tirzepatide (Mounjaro, Zepbound), orforglipron (Foundayo), retatrutide and eloralintide — and said the goal is to offer the broadest set of options, because a condition this common will not be well served by a single drug [1].
Ken Custer, executive vice president and president of Lilly Cardiometabolic Health, framed the size of the gap. He said there are "arguably 100 million or more people living with obesity" in the United States and probably 2 billion worldwide, yet fewer than one in 10 Americans who could benefit from an incretin medicine are taking one. "We're in the low single digits in terms of reaching people that we could help," he said [1].
Orforglipron drew much of the attention. Lilly said the pill received US marketing authorization in April for weight management, followed by authorization in the United Arab Emirates, and that it has submitted for type 2 diabetes and weight management in 45 countries, with the type 2 submission to be complete in the second quarter of 2026. The program includes seven completed registration studies covering more than 10,000 patients and six more phase 3 trials underway [1].
In the ACHIEVE program in type 2 diabetes, the highest orforglipron dose lowered HbA1c by 1.5% to 2.2%, from a baseline of about 8%, landing near 6%. In ACHIEVE-3, which enrolled about 1,700 patients with type 2 diabetes, weight loss reached up to 9.2% with the higher orforglipron dose, compared with up to 5.3% for the two approved doses of oral semaglutide (Rybelsus); Lilly said both orforglipron doses were statistically superior on HbA1c and weight. In ATTAIN-1, with more than 3,000 patients without type 2 diabetes, weight loss reached up to 12.4%, and in ATTAIN-2, in patients with type 2 diabetes, 10.5% [1].
The most common side effects were gastrointestinal, mostly mild to moderate and transient, with discontinuation across studies running about 4% to 12%, according to Thomas Seck, Lilly's senior vice president of product development [1].
For the older injectable tirzepatide, Lilly said the medicine has market-leading share and standard-of-care status in obesity and diabetes, that SURPASS-CVOT results are expected in US and international labels "soon," and that SURMOUNT-MAINTAIN tested alternative maintenance doses of Zepbound. Earlier head-to-head data showed superiority versus 2.4 mg Wegovy [1].
Retatrutide was described as the anticipated third Lilly obesity medicine, with TRANSCEND-T2D-1 and TRIUMPH-1 data presented the same day and other indications underway. Eloralintide is in five phase 3 studies, and Lilly said it has shown incretin-like efficacy with more placebo-like gastrointestinal tolerability. Data on eloralintide combined with tirzepatide are expected later this year [1].
Why it matters for patients
More than one approved medicine in this class means differences in how drugs are taken and tolerated could matter more in everyday use. Orforglipron is a daily pill, while tirzepatide, retatrutide and eloralintide are injectables in Lilly's lineup [1].
The MAINTAIN studies looked at what happens after substantial weight loss on an injectable. Switching from injectable Wegovy (semaglutide) to orforglipron held about 95% of the weight lost, and switching from the maximum tolerated Zepbound dose to orforglipron preserved about 76%, according to Lilly. Seck noted these are comparisons across studies and treatment arms, "which has some limitations" [1].
Pricing, insurance coverage and launch timing for retatrutide and eloralintide were not disclosed at the event [1].
What happens next
Lilly said two orforglipron comparisons will be presented at an ADA symposium on Monday: ACHIEVE-2 versus dapagliflozin and ACHIEVE-3 versus oral semaglutide, along with ACHIEVE-5 in patients on insulin compared with placebo [1]. The company expects to complete its US type 2 diabetes submission in the second quarter of 2026 and to report eloralintide-plus-tirzepatide data later this year [1].
Sources
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