Here's a simplified framework for thinking about it:

• Maximum weight loss → Triple agonists (retatrutide) or combination therapies (CagriSema)
• No injections → Oral options (orforglipron, oral sema 50mg, danuglipron)
• Liver disease (MASH) → Drugs with GCG component (survodutide, retatrutide)
• Muscle preservation → Watch for bimagrumab combinations
• Less frequent dosing → Monthly options (ecnoglutide, maritide)
• Lowest cost (eventually) → Oral small molecules (orforglipron)

But honestly, for most patients right now, the answer is: take what's available and covered by your insurance. The pipeline drugs are 1-3+ years from reaching your pharmacy.

Updated the table with the suggestions above. One thing I want to add: by my count, there are currently over 100 obesity drugs in clinical development worldwide. I've only listed the most significant ones. The sheer volume of investment in this space is unprecedented in pharmaceutical history.

For context, the global anti-obesity drug market was ~$6 billion in 2023 and is projected to exceed $150 billion by 2030. That kind of market opportunity attracts every pharmaceutical company on the planet. Competition will ultimately benefit patients through better drugs and lower prices.

Pinning this thread as a reference resource., would you be willing to update the tables quarterly? We could make this a living document for the community.

Reminder to everyone: pipeline drugs are NOT available for prescription outside of clinical trials. If someone offers to sell you "retatrutide" or "orforglipron" online, it is not the pharmaceutical product. Please report any posts advertising unregulated pipeline drugs.