The GLP-1 market is about to get crowded. Beyond the retatrutide and orforglipron deep dives, there's a full pipeline of drugs from Novo Nordisk, Viking Therapeutics, Boehringer Ingelheim, and smaller players—each with different mechanisms, efficacy profiles, and timelines.
This is the complete ranking of every significant drug in development.
The Efficacy Hierarchy
| Rank | Drug | Mechanism | Route | Peak Weight Loss | Status |
|---|---|---|---|---|---|
| 1 | Retatrutide Eli Lilly |
Triple | Injectable | ~29% | Phase 3 |
| 2 | CagriSema Novo Nordisk |
GLP-1 + Amylin | Injectable | ~25% | Phase 3 |
| 3 | Tirzepatide Eli Lilly |
GLP-1 + GIP | Injectable | ~22% | Approved |
| 4 | Survodutide Boehringer Ingelheim |
GLP-1 + Glucagon | Injectable | ~19% | Phase 3 |
| 5 | UBT251 Novo Nordisk |
Triple | Injectable | ~20%+ | Phase 2 |
| 6 | Orforglipron Eli Lilly |
GLP-1 Oral | Oral | ~15% | Phase 3 |
| 7 | Amycretin Novo Nordisk |
GLP-1 + Amylin Oral | Oral | ~15%+ | Phase 2 |
| 8 | Semaglutide Novo Nordisk |
GLP-1 | Injectable | ~15% | Approved |
| 9 | VK2735 Viking |
GLP-1 + GIP Oral | Oral | ~12%* | Phase 2 |
*VK2735 achieved 12.2% in just 13 weeks—fastest trajectory in the field, but high discontinuation rate.
Key Pipeline Drugs in Detail
CagriSema
Novo Nordisk
~25%
Weight Loss
Weekly
Injection
2026
Expected
Mechanism: Semaglutide + Cagrilintide (Amylin)
Combines proven semaglutide with cagrilintide, a long-acting amylin analog. Amylin is a pancreatic hormone co-secreted with insulin that powerfully promotes satiety. Unlike GIP or glucagon-based combinations, amylin works through distinct brain pathways—potentially additive effects without the nausea ceiling of high-dose GLP-1.
Key Insight
This is Novo Nordisk's answer to tirzepatide. By combining their blockbuster semaglutide with a novel amylin analog, they're pushing toward the ~25% weight loss tier without needing glucagon (avoiding heart rate concerns). Phase 3 REDEFINE program ongoing.
Survodutide (BI 456906)
Boehringer Ingelheim / Zealand Pharma
~19%
Weight Loss
Weekly
Injection
2026-27
Expected
Mechanism: GLP-1 + Glucagon (Dual Agonist)
Similar glucagon component to retatrutide (thermogenesis, liver fat oxidation) but without GIP. Phase 2 showed ~19% weight loss at 46 weeks. Strong liver fat reduction makes it a potential MASH treatment.
Key Insight
Positioned primarily for MASH (liver disease) rather than pure obesity. May find its niche in patients with significant fatty liver disease where the glucagon-driven hepatic effects are most valuable.
Amycretin (Oral)
Novo Nordisk
13.1%
At 12 Weeks
Daily
Pill
2027+
Expected
Mechanism: Oral GLP-1 + Amylin Co-Agonist
Novo's oral contender. Uses the same GLP-1/amylin combination as CagriSema but in pill form. Early Phase 1 data showed 13.1% weight loss at just 12 weeks—impressive trajectory for an oral.
Key Insight
If successful, this is Novo's answer to Lilly's orforglipron. The amylin component may offer better GI tolerability than pure GLP-1 orals, and it avoids the heart rate increases seen with glucagon-based drugs. Phase 3 starting 2026.
VK2735 (Oral)
Viking Therapeutics
12.2%
At 13 Weeks
Daily
Pill
Phase 3
Entering
Mechanism: Oral GLP-1/GIP Dual Agonist
Viking's oral dual agonist. Achieved 12.2% weight loss in just 13 weeks in VENTURE-Oral trial—the fastest trajectory of any oral in development. Also developing an injectable version.
Key Insight
The efficacy is impressive, but tolerability is the issue: 38% discontinuation rate at highest dose due to severe nausea. Viking is exploring slower titration to address this. If they solve the GI problem, this could be a serious orforglipron competitor.
UBT251
Novo Nordisk (acquired from United Labs)
15.1%
At 12 Weeks
Weekly
Injection
Phase 2
Early
Mechanism: Triple Agonist (GLP-1/GIP/Glucagon)
Novo acquired this for $200M upfront + $1.8B milestones in March 2025. Same mechanism as retatrutide. Phase 1b showed 15.1% weight loss in just 12 weeks—potentially "hotter" than retatrutide's early trajectory.
Key Insight
Novo's hedge against Lilly's retatrutide. Even if retatrutide wins FDA approval first, Novo now has their own triple agonist in the pipeline for the "maximum efficacy" segment.
The Two Market Segments Emerging
The pipeline reveals a clear strategic bifurcation:
Maximum Efficacy (Injectables)
For patients with severe obesity (BMI >40) or those who need >25% weight loss to resolve comorbidities like heart failure or sleep apnea. Drugs: Retatrutide, CagriSema, UBT251. Trade-off: higher side effect burden, higher cost.
Maximum Accessibility (Orals)
For the broader obesity population, maintenance after initial loss, and patients who refuse/can't tolerate injections. Drugs: Orforglipron, Amycretin, VK2735. Trade-off: ~15% weight loss ceiling, but scalable manufacturing and lower cost.
The likely treatment model: induction with high-efficacy injectables → maintenance with affordable orals.
Timeline Summary
| Year | Drug | Milestone |
|---|---|---|
| 2026 | Orforglipron | FDA Approval (Q2) |
| 2026 | CagriSema | FDA Filing / Potential Approval |
| 2026-27 | Survodutide | FDA Decision (MASH indication) |
| 2027 | Retatrutide | FDA Approval |
| 2027+ | VK2735, Amycretin | Phase 3 Readouts / Filings |
Sources
Company pipeline disclosures; ClinicalTrials.gov; Analyst projections from investor presentations (Eli Lilly, Novo Nordisk, Viking Therapeutics, Boehringer Ingelheim).
The Bottom Line
By 2027, the GLP-1 market will look completely different. The ~15% weight loss of current semaglutide will be the floor, not the ceiling. Injectable options will push toward 25-30% weight loss (CagriSema, retatrutide), approaching bariatric surgery efficacy. Oral options (orforglipron, amycretin) will make GLP-1s as accessible as statins—daily pills at ~$200-350/month. For patients: wait for orforglipron (2026) if you want a pill; wait for retatrutide (2027) if you need maximum efficacy. For everyone else: tirzepatide (Zepbound) remains the best currently available option until these arrive.
Sources
- Novo Nordisk. REDEFINE Phase 3 Program (CagriSema).
- Novo Nordisk. UBT251 Acquisition Press Release. March 2025.
- Novo Nordisk. Amycretin Phase 1 Data.
- Boehringer Ingelheim. Survodutide Phase 2 Results.
- Viking Therapeutics. VENTURE-Oral Phase 2 Results.
- Eli Lilly. TRIUMPH Program (Retatrutide).
- Eli Lilly. ATTAIN Program (Orforglipron).
- ClinicalTrials.gov registrations for all listed drugs.