Obesity drug pipeline widens beyond GLP-1 as elecoglipron, aleniglipron and petrelintide advance
More obesity drugs are moving into late-stage testing, including pills and a non-GLP-1 injection, though the earliest estimated approvals are years away.
Obesity drug development is widening beyond GLP-1 medicines, with several new programs entering late-stage testing. AstraZeneca has moved its oral drug elecoglipron into Phase 3 [1], Structure Therapeutics has begun dosing patients in a Phase 3 program for oral aleniglipron [1], and Zealand Pharma and Roche are advancing petrelintide, an amylin analog given as a weekly injection [1][2].
A drug-intelligence platform that tracks obesity and weight-related programs counts more than 150 active programs, from preclinical development through Phase 3 [1]. The field now includes amylin receptor agonists, glucagon-targeting drugs, RNAi therapies aimed at the genes INHBE and ALK7, CB1 antagonists, and treatments designed to preserve muscle [1]. Worldwide, more than 1 billion people were living with obesity in 2022, including about 890 million adults [1].
Elecoglipron and aleniglipron are both daily oral small molecules that act on the GLP-1 receptor. In earlier studies, elecoglipron produced an average 11.8% body-weight loss at 36 weeks, and aleniglipron produced 15.3% at 44 weeks, according to one comparison table [1]. Those figures come from separate trials with different designs and should not be read as a head-to-head ranking [1]. The same table lists an estimated approval date of July 2031 for elecoglipron; for aleniglipron, no estimated approval date has been disclosed [1].
Petrelintide works differently. It is a long-acting amylin analog and does not act on the GLP-1 receptor [1]. In the Phase 2 ZUPREME-1 trial, it produced up to 10.7% average weight loss at 42 weeks. At the maximally effective dose, the developers reported no vomiting and no treatment discontinuations caused by gastrointestinal side effects, with overall tolerability similar to placebo [1]. Roche paid $1.65 billion upfront for rights to the drug [2]. A Phase 3 program is due to begin in the second half of 2026, and the tracker lists an estimated approval date of April 2031 [1][2].
Other non-GLP-1 approaches are earlier in testing. Wave Life Sciences' WVE-007, an RNAi therapy targeting INHBE, produced a placebo-adjusted 14.3% reduction in visceral fat at six months in an early Phase 1 study while lean mass was maintained; total body-weight reduction was modest [1]. Myostatin and activin inhibitors are also being studied for their effects on muscle and body composition [1].
For now, the approved obesity medicines include injectable Wegovy and Zepbound, the oral Wegovy pill approved in December 2025, and Foundayo, or orforglipron, approved April 1, 2026 [1][2]. CagriSema, a combination of semaglutide and the amylin analog cagrilintide, is under FDA review after Novo Nordisk filed in December 2025, with a decision expected later in 2026 [1][2].
Why it matters for patients
Most of the drugs moving through late-stage testing are still investigational, and none in this new group is approved. The estimated approval dates listed for several of them run from 2029 to 2031 [1]. Not all of the more than 150 programs now in development will succeed [1].
Petrelintide's tolerability results are notable for people who struggle with the gastrointestinal side effects of current obesity drugs, but many of the most advanced candidates still use GLP-1 signaling, so switching among them would not necessarily avoid nausea or vomiting [1].
Competition may also affect what patients pay. Foundayo's manufacturer self-pay program starts at $149 per month depending on dose, Lilly's self-pay pricing for Zepbound starts at $299 per month, and Novo Nordisk offers self-pay pricing for oral Wegovy starting at $149 per month [1]. Since July 2026, eligible Medicare Part D beneficiaries have been able to get certain approved GLP-1 obesity medicines for $50 per month through a temporary program [1]. Those programs can change, and they are not the same as a drug's list price or an insured patient's out-of-pocket cost [1]. Whether a larger field of competing medicines leads to broadly lower prices is not yet known [1].
What happens next
Petrelintide's Phase 3 program is scheduled to begin in the second half of 2026 [2]. An FDA decision on CagriSema is expected later in 2026 [1][2]. For retatrutide, Lilly has said it plans to submit its obesity application to the FDA in the first quarter of 2027 [1], while a separate report says a filing is widely anticipated by the end of 2026 [2]; the two accounts differ. Estimated approval dates listed for other late-stage candidates include October 2029 for zenagamtide, February 2031 for survodutide, April 2031 for petrelintide and July 2031 for elecoglipron [1].
Sources
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