Articles / Oral GLP-1
After the first two pills: the next wave of oral obesity drugs
Aleniglipron, elecoglipron, oral VK2735, CT-996 and more. What the second wave of obesity pills has shown so far, and the three things that will separate them.
Published Oct 23, 2026 ยท 4 min read
Until December 2025 there was no pill for obesity in the GLP-1 class. Now there are two: Novo Nordisk's Wegovy pill (oral semaglutide 25 mg) and Eli Lilly's Foundayo (orforglipron). Behind them, at least five more oral drugs are in mid- or late-stage trials. The second wave matters because pills are cheaper to make at scale, need no cold chain or injection, and could reach far more people than weekly shots.
Two kinds of pill
The Wegovy pill is a peptide, the same molecule as the injection, packed with an absorption enhancer. Most of the dose is still destroyed in the gut, so it needs a high dose and strict rules: an empty stomach and a wait before eating. Foundayo is a small molecule, a chemical built to switch on the GLP-1 receptor without being a peptide at all. It is absorbed easily and can be taken without food rules. Most of the second wave are small molecules, following Foundayo's route. (For the head-to-head of the first two, see Wegovy pill vs Foundayo.)
The next oral drugs
| Drug, company | Type | Latest trial | Weight loss | Stage |
|---|---|---|---|---|
| Aleniglipron, Structure Therapeutics | GLP-1, small molecule | ACCESS II, 44 weeks | 16.3% more than placebo (180 mg) | Phase 3 start guided for Q3 2026 |
| Elecoglipron, AstraZeneca | GLP-1, small molecule | VISTA, 36 weeks | 11.8% vs 0.3% on placebo (75 mg) | Phase 3 (EMBOLD, ELUMINATE) |
| Oral VK2735, Viking Therapeutics | GLP-1 + GIP | VENTURE-Oral, 13 weeks | 12.2% vs 1.3% on placebo (120 mg) | Phase 3 start guided for Q4 2026 |
| CT-996, Roche | GLP-1, small molecule | Phase 1, 4 weeks | 6.1% more than placebo | Phase 2 |
| Naperiglipron, Eli Lilly | GLP-1, small molecule | Not yet reported | n/r | Phase 2 |
| Amycretin, Novo Nordisk | Amylin + GLP-1 | Tested as a shot and a tablet | n/r for the tablet | Phase 3 programme |
For reference: Wegovy pill 16.6% at 64 weeks (OASIS 4), Foundayo 12.4% at 72 weeks (ATTAIN-1), both on treatment. Trials differ in length from 4 to 72 weeks, so these are not like-for-like comparisons.
Aleniglipron: the efficacy leader on paper
Structure Therapeutics reported placebo-adjusted weight loss of 16.3% at 180 mg and 16.0% at 240 mg after 44 weeks, with no plateau yet. That is the largest figure for any small-molecule GLP-1 pill so far, though on a placebo-adjusted basis over a shorter trial than ATTAIN-1, and the release did not give side-effect dropout rates. The FDA agreed a Phase 3 design starting at a low 2.5 mg dose, which points to tolerability as the thing to watch. Structure also has an oral amylin drug in Phase 1, with a second due to start.
Elecoglipron: AstraZeneca's entry
In VISTA, published in The Lancet in June 2026, 310 adults lost 11.8% at 36 weeks on 75 mg, against 0.3% on placebo. In SOLSTICE, a type 2 diabetes trial, it lowered HbA1c by 1.9 points, more than the 1.3 points on open-label oral semaglutide 14 mg. Stomach side effects were frequent: in VISTA, nausea affected 55% against 20% on placebo, and vomiting 29% against 5%. AstraZeneca says discontinuations were infrequent but gave no figure, and used the Phase 2 tolerability data to set the Phase 3 dose escalation.
Oral VK2735: fast results, high dropouts
Viking's tablet produced 12.2% weight loss in only 13 weeks at the top dose, a fast rate. The cost was tolerability: 20% of participants on the drug stopped for side effects against 13% on placebo, and 38% of the top-dose arm discontinued for any reason. Its Phase 3 programme is guided to start in late 2026.
What to watch
Three things will separate the second wave. First, dropouts: every oral candidate so far has high stomach side-effect rates, and the companies are reworking dose increases for Phase 3. Second, liver safety: earlier small-molecule GLP-1 drugs from other companies were stopped over liver signals, and AstraZeneca reports none for elecoglipron so far. Third, combinations: oral amylin drugs could eventually be paired with oral GLP-1 drugs, in the same way CagriSema pairs the injections.
All of these drugs appear in our pipeline map; filter by "Pills" to see the full oral field.
General information, not medical advice. Sources: Structure Therapeutics, Q1 2026 results; AstraZeneca, elecoglipron Phase IIb results; Viking Therapeutics, VENTURE-Oral; Genentech, CT-996 Phase 1; Midgard Finance pipeline tracker; Eli Lilly, ATTAIN-1; OASIS 4, NEJM 2025.