I've put together a comprehensive comparison table of every significant obesity/metabolic drug in the pipeline. Sharing here for reference. Corrections welcome — this field moves fast.

Late-Stage Pipeline (Phase 3)

Mid-Stage Pipeline (Phase 2)

Early-Stage / Preclinical

Last updated: March 2026. Data sourced from ClinicalTrials.gov, company press releases, and published trial results.

Excellent resource, thank you for compiling this. A few additions/corrections:

• Maritide (AMG 133): Worth emphasizing how unique Amgen's approach is. They're BLOCKING the GIP receptor while agonizing GLP-1. This is the opposite of tirzepatide (which agonizes both). The fact that both approaches produce significant weight loss highlights how poorly we understand GIP physiology. Is GIP agonism or antagonism better? The data says... both work? 🤷
• Ecnoglutide should probably be on your mid-stage table — it's the monthly GLP-1 RA we discussed in the other thread
• Semaglutide + cagrilintide SC monthly: Novo has mentioned a monthly co-formulation in their pipeline, distinct from the weekly CagriSema

The GIP agonism vs. antagonism paradox is one of my favorite puzzles in this field. Here's how I think about it:

GIP receptor signaling is context-dependent. In the setting of obesity and insulin resistance, GIP promotes adipose tissue lipid storage. Blocking it (Amgen's approach) prevents that. But in the setting of acute meal ingestion, GIP agonism potentiates insulin release and may reduce nausea (Lilly's approach).

Both produce weight loss, but potentially through different downstream mechanisms. It's possible that the "optimal" approach depends on the individual patient's metabolic phenotype. This is the kind of complexity that makes obesity pharmacology so fascinating and so difficult.

Looking at this table, the elephant in the room is price and access. We could have 50 amazing drugs in the pipeline, but if they're all priced at $1,000+/month and insurance won't cover them, it doesn't matter for most people.

The drugs I'm most excited about from an ACCESS perspective are the oral small molecules (orforglipron, danuglipron) because they have the manufacturing cost profile to eventually be affordable. Biologic injectables will always carry a price premium.

This is overwhelming honestly. There are so many drugs in development! How is a patient supposed to know which one to wait for or ask about? Is there a simple way to think about which type might be best for different situations?