Elecoglipron, CagriSema, and the Expanding GLP-1 Pipeline

The GLP-1 pipeline in mid-2026 is the most active in the drug class's history. Multiple new agents are either recently approved, awaiting FDA decision, or advancing through late-stage trials. Here's the complete landscape.

Recently Approved (2025-2026)

Foundayo (orforglipron) — Eli Lilly

FDA-approved April 1, 2026. First non-peptide small-molecule GLP-1 RA for obesity. Once-daily oral pill. ATTAIN-1 trial: 12.4% mean weight loss at 72 weeks. Now commercially available.

Ozempic Tablets — Novo Nordisk

Launched May 4, 2026 at 70,000+ US pharmacies. Oral semaglutide in 1.5mg, 4mg, 9mg doses. Approved for T2DM with expanded cardiovascular indication. Self-pay: $149/month via NovoCare.

Oral Wegovy — Novo Nordisk

FDA-approved December 2025 for weight management. First oral GLP-1 specifically indicated for obesity.

Awaiting FDA Decision (2026)

CagriSema (cagrilintide/semaglutide) — Novo Nordisk

Fixed-dose combination of amylin receptor agonist cagrilintide + semaglutide. Once-weekly injection via dual-chamber device. REDEFINE 1 trial: 22.7% mean weight loss at 68 weeks, with >40% of participants achieving ≥25% reduction. If approved, first amylin/GLP-1 combination for weight management. FDA decision expected 2026.

Wegovy 7.2mg — Novo Nordisk

Higher dose of semaglutide for patients who may benefit from increased exposure. Under FDA review.

Mounjaro cardiovascular indication — Eli Lilly

New indication for tirzepatide to reduce MACE risk in T2DM patients. FDA submission based on SURPASS-CVOT data.

Advancing Through Trials

Elecoglipron — AstraZeneca

Once-daily oral small-molecule GLP-1 RA. Phase IIb VISTA and SOLSTICE results presented at ADA 2026, published in The Lancet. Entering extensive Phase III program in obesity and T2DM including cardiovascular and kidney outcome trials. Estimated availability: 2028-2029.

Pemvidutide, Maritide, Survodutide

Multiple triple-agonist candidates (GLP-1/GIP/glucagon) in Phase II-III development from various manufacturers. These next-generation combinations aim to produce even greater weight loss while potentially preserving more lean mass.

What This Means

By 2028, patients may have 8-10+ GLP-1 options across oral and injectable formats, from at least 4-5 manufacturers. This level of competition historically drives prices down, quality up, and access wider. The era of two-company dominance in GLP-1 therapy is ending.