Novo Nordisk · Ozempic / Wegovy / Rybelsus
Semaglutide
one pathway: GLP-1
Weight loss (2.4 mg)~15%
High doseWegovy HD 7.2 mg: ~21%
Routeweekly shot + pill
Statusapproved
Documentary · the GLP-1 class · June 2026
How high can it go?
In three years one weekly shot climbed from 15% of body weight to nearly 30%, the territory of bariatric surgery. Each generation adds a receptor. Beside the pharmacy, a grey market grew where the same molecule sells for 15 dollars a vial.
6
molecules approved for weight loss*
10+
candidates in late-stage trials
30%
body weight lost, top of the pipeline
$328M
peptides imported from China, 9 mo. 2025
On the shelf · 6 approved molecules
What you can get today, with a prescription
Two firms run the market: Novo Nordisk (semaglutide) and Eli Lilly (tirzepatide). Through 2025 and 2026 the shelf widened with a high injectable dose and, for the first time, with real pills.
Eli Lilly · Mounjaro / Zepbound
Tirzepatide
two pathways: GLP-1 + GIP
Weight loss (15 mg)~22,5%
Best in classmost effective approved
Routeweekly shot
Statusapproved
Eli Lilly · Foundayo
Orforglipron
one pathway: GLP-1, non-peptide pill
Weight loss (72 wk)12,4%
Edgeno fasting, no water rules
Routedaily pill
Statusapproved 1 Apr 2026
Novo Nordisk · Wegovy / Ozempic tablets
Oral semaglutide
first GLP-1 pill for weight loss
Weight loss (25 mg)~15%
LaunchJan 2026; 1 m in 4 months
Routedaily pill, empty stomach
Statusapproved Dec 2025
*Plus older agents still sold but outclassed: liraglutide (Saxenda, ~8%, daily shot), dulaglutide, exenatide. For diabetes, the same molecules carry different brand names.
The ladder · the centrepiece
The whole class on one axis
Body weight lost in the headline trial, at the top dose. Colour shows how many hormone pathways the molecule engages: one, two, or three. Tap a point for detail and source. Grey ones are not approved, and their numbers come from early trials or from outside regulation.
1 path
2 paths
3 paths
Tap a point on the ladder to see the molecule, its mechanism, its best data and the source.
The mechanism · why the ladder climbs
One receptor, two, three
GLP-1 is a hormone the gut releases after a meal: it slows the stomach, blunts appetite, helps the pancreas with insulin. The drugs mimic it. The jump in efficacy came from packing more hormones into the same molecule.
01
One pathway: GLP-1
Semaglutide, liraglutide, orforglipron. Appetite drops, weight follows, around 12–15%. The foundation of the whole class.
02
Two pathways: + GIP or glucagon
Tirzepatide adds GIP and reaches ~22.5%. Survodutide adds glucagon, which burns more energy. Amylin combinations (CagriSema) press a different satiety button.
03
Three pathways: GLP-1 + GIP + glucagon
Retatrutide, the triple agonist. 30.3% at 104 weeks: surgery territory. The press calls it GLP-3, but that is a nickname, not a real class.
??
"Five GLP-1s in one"
It does not exist. The most any single molecule hits is three pathways (retatrutide, UBT251). The inflated number comes from the grey market, where people inject several peptides at once, or from marketing.
Reading note
"More pathways" does not automatically mean "better for everyone". Glucagon can raise blood sugar and pressure in some patients; the combinations need slow titration. The number on the ladder is a trial average, not a personal promise.
In the pipe · the 2026–2028 wave
What comes after Ozempic
This is no longer a two-horse race. Amgen, Boehringer, Roche, Viking and a string of Chinese firms are pushing molecules with different mechanisms. Those below have phase 2 or 3 data.
| Molecule | Maker | Mechanism | Best number | Status |
|---|---|---|---|---|
| RetatrutidăEli Lilly | Eli Lilly | 3 paths: GLP-1+GIP+glucagon | 30,3% / 104 săpt. | phase 3, decisions 2026+ |
| CagriSema | Novo Nordisk | GLP-1 + amylin | 22,7% / 68 săpt. | FDA filed, Dec 2025 |
| Zenagamtidă (amycretin) | Novo Nordisk | GLP-1 + amylin, one molecule | ~22% / 36 săpt. | phase 3 (AMAZE) |
| MariTide | Amgen | GLP-1 agonist + GIP blocked | ~20% / 52 săpt. | phase 3 (MARITIME), monthly |
| Survodutidă | Boehringer Ingelheim | GLP-1 + glucagon | ~15–19% / 46 săpt. | phase 3, ADA 2026 data |
| VK2735 | Viking Therapeutics | GLP-1 + GIP | phase 3 (VANQUISH) | shot + pill |
| UBT251 | United Labs / Novo | 3 paths (China's triple) | phase 2 | global phase 2, H2 2026 |
| CT-388 · Pemvidutidă | Roche · Altimmune | GLP-1 + GIP / glucagon | phase 2 | in development |
The decision calendar
- Dec 2025Wegovy pill (oral semaglutide) approved in the US. Novo files for CagriSema.
- Mar 2026First positive phase 3 for retatrutide in diabetes (TRANSCEND-T2D-1).
- Apr 2026Orforglipron (Foundayo) approved: first non-peptide GLP-1 pill for weight loss.
- May 2026Retatrutide, phase 3 in obesity (TRIUMPH-1): 28.3% at 80 weeks, 30.3% at 104.
- 2026–2027FDA decision on CagriSema; survodutide and VK2735 readouts; phase 3 for amycretin and MariTide.
The turn · from needle to pill
The pill changes who gets the drug
The shot was always the barrier: a fridge, needles, hesitation. A pill is cheaper to make, ships like any other tablet, and reaches millions who would never have started with a needle. That is what the 2026 fight is about.
| Pill | Maker | Detail | Status |
|---|---|---|---|
| Oral semaglutide (Rybelsus / Wegovy) | Novo | peptide; empty stomach, 30-min fast | approved (weight loss, Dec 2025) |
| Orforglipron | Lilly | non-peptide; no fasting, any time | approved Apr 2026 |
| Oral amycretin | Novo | GLP-1 + amylin; ~13% at 12 wk | phase 3 planned |
| VK2735 oral | Viking | GLP-1 + GIP; also injectable | early phase |
The world without colour · the grey market
The same molecule, 15 dollars a vial
On the ladder above, approved retatrutide and the "reta" from Discord sit at the same height: it is the same molecule. Everything else is the difference. One runs through phase 3 trials and years of review. The other arrives as powder from a Chinese factory, labelled "for research use only", and is injected at home.
$328M
peptides imported from China in the first 9 months of 2025, double the year before.
$15↔$200
one vial direct from the factory versus the same product through a middleman.
0
FDA approvals for these peptides in humans, beyond the GLP-1s already cleared.
Reporters in San Francisco describe a subculture that left the biohacker niche and reached TikTok: "peptide parties", a "Chinese Peptide Rave" in a coworking space where people learned injection technique. To get past platform filters, nobody says "retatrutide". They say something else.
retaGLP-3ratatouillepeppersresearch use only
"For research use only" is a legal fiction. The sellers know what the vials are for. Blockchain analysis followed the money: some Chinese suppliers are the same chemical factories that once shipped fentanyl precursors to trafficking networks and pivoted to peptides for lower risk. On one forum, a "trusted" 30 mg batch of retatrutide failed a sterility test when a careful buyer checked it independently.
What the label does not say. Without regulation there is no guarantee of purity, sterility or dose. Retatrutide is approved by no agency; Eli Lilly explicitly warns against taking anything sold as retatrutide outside its trials. This is a description of the phenomenon, not a guide: no sources, doses or methods are included here.
The money · the price falls
From 1,000 dollars to 149
The market was valued at 66 billion dollars in 2025 and is projected toward 185 by 2033. In the US, the temporary Medicare GLP-1 Bridge began on 1 July 2026 for certain eligible Part D beneficiaries. Figures are dollars per month.
$1,000+
List price for the injectables, before the deals.
$499
Direct to consumer (LillyDirect, NovoCare) before cuts.
$350
TrumpRx, injectables; trending to $245 over two years.
$245
Medicare GLP-1 Bridge net price for one month of Foundayo, Wegovy (injection or tablet), or Zepbound KwikPen. An eligible beneficiary pays a $50 copay.
$149
Starter dose of the pills (orforglipron) via TrumpRx. The cheapest legal entry point.
The Bridge is a temporary demonstration outside the normal Part D payment flow, scheduled through 31 December 2027. Access requires clinical criteria and prior authorisation. The $50 copay does not count towards the Part D deductible or annual out-of-pocket limit. Ozempic and Mounjaro are not on the Bridge list for weight management; they may appear separately under Part D coverage for eligible indications.
What we don't know · open ends
The questions that would change the picture
| Open question | What the data shows now |
|---|---|
| Muscle or fat? | Between a quarter and ~40% of the weight lost is lean mass, not fat. Some studies call it proportional and manageable with resistance training; others fear sarcopenia in older adults. The debate is open. |
| What happens when you stop? | Weight returns about four times faster than after a diet, back toward baseline in roughly a year and a half. Obesity behaves like a chronic, relapsing disease. |
| How many stay on? | Real-world data: up to 65–70% stop within the first year, driven by cost and gut side effects. Adherence, not efficacy, is the bottleneck. |
| Long-term safety of the triples? | Retatrutide has at most a few years of data. Glucagon needs watching for blood sugar and pressure. The cardiovascular and renal trials, the ones that truly matter, are only now finishing. |
| How much harm from the grey market? | Unknown and unmeasured. Without regulated reporting, contamination, wrong dosing and adverse events stay outside any statistic. |
This is a documentary page, not medical advice. Decisions about these drugs belong with a doctor, based on each person's situation.
Sources · checked in session
Where the numbers come from
Primary: companies, agencies, trials
- Eli Lilly, TRIUMPH-1 (retatrutidă, obezitate, 28,3% / 30,3%): PR Newswire, 21 mai 2026; lilly.com.
- Eli Lilly, TRANSCEND-T2D-1 (retatrutidă, diabet): investor.lilly.com, 19 mar. 2026.
- FDA / Eli Lilly, orforglipron (Foundayo) aprobat: Lilly, 1 apr. 2026; Drugs.com, istoric FDA.
- Novo Nordisk, CagriSema (REDEFINE 1, dosar FDA): PR Newswire, 18 dec. 2025; Novo, Form 6-K SEC.
- Novo Nordisk, amycretin / zenagamtidă și pastila Wegovy (OASIS): PR Newswire, 27 mai 2026.
- Amgen, MariTide (faza 2, NEJM): Amgen Investors.
- Viking Therapeutics, VK2735 (VANQUISH): PR Newswire, 26 mar. 2026.
- Novo Nordisk / United Laboratories, UBT251 (triplu agonist): GlobeNewswire.
- Medicare GLP-1 Bridge: CMS, produse, eligibilitate și flux Part D; Medicare, ghid pentru beneficiari. Verificat la 15 iulie 2026.
First-rate press and analysis
- The peptide grey market, China and Silicon Valley: TechSpot; Scientific American; Chainalysis.
- GLP-1 pipeline and the 2026 pills: GoodRx; Prime Therapeutics; PharmaVoice.
- Muscle, regain, adherence on stopping: eClinicalMedicine, 2026; IAPAM (meta-analiză BMJ).
- Market size: Grand View Research.
Honesty note: weight-loss figures are trial averages at the top dose, across trials with different populations and durations, so they are not strictly head-to-head. Phase 2 numbers (MariTide, survodutide, VK2735, UBT251) may shift in phase 3. The grey-market figures rest on customs data and reporting, not official registries.