Two mid stage trials published this month show once daily GLP 1 pills, the drug class behind Ozempic and Wegovy, hitting up to 12% body weight loss at 36 weeks and exposing a split between two competing chemical strategies to replace the weekly shot.
The weight-loss drugs behind Ozempic and Wegovy have a single most-cited inconvenience: they are weekly self-injections. Two peer-reviewed trials published this month show that the field's race to replace the shot with a daily pill is not one race but two, built on chemically opposite bets about how to get the drug through the stomach intact.
Both new candidates are once-daily oral GLP-1 receptor agonists, the gut-hormone-mimicking drug class that drives Ozempic, Wegovy, and the broader injectable GLP-1 market. A Lancet publication for AstraZeneca's elecoglipron, announced by the company alongside its move into Phase III, and a Nature Medicine paper for Structure Therapeutics' aleniglipron covered in this Gizmodo overview of the oral GLP-1 field, both reported up to roughly 12% body-weight loss at 36 weeks in their top-dose arms. That range sits in the neighborhood of weight-loss figures reported for injectable semaglutide in its pivotal trials, though the new numbers are mid-stage, dose-arm top-line results rather than head-to-head readouts against the weekly shot. (Phase II is the mid-stage study that tests whether a drug works and how tolerable it is, ahead of the larger Phase III trials that typically support approval.)
Why the field has split into two strategies comes down to chemistry. The original GLP-1 drugs are peptides, large protein-like molecules that stomach acid chews up before they reach the bloodstream. The first pill workaround, used by the late-2025 FDA-approved oral Wegovy, pairs the peptide with an absorption booster called SNAC (salcaprozate sodium) that helps the drug survive gastric transit. The newer bet, taken by aleniglipron, elecoglipron, orforglipron, and ASC30, is to abandon peptides entirely and design small-molecule GLP-1 receptor agonists, chemically smaller compounds built from the start to withstand the stomach without an absorption helper. Eli Lilly's orforglipron, now branded Foundayo, won FDA approval in April 2026 on that small-molecule path.
The two paths are not interchangeable. Small-molecule pills are cheaper to manufacture at scale, more amenable to fixed-dose combinations, and easier to formulate at different strengths. SNAC-boosted peptide pills keep the active ingredient closer to the proven injectable but carry the cost and supply-chain complexity of peptide production, which has been the main constraint on injectable GLP-1 supply since 2023. For a class that may eventually be prescribed to hundreds of millions of people for obesity, diabetes, and adjacent conditions, that difference is not cosmetic.
The two newest candidates sit firmly on the small-molecule side. AstraZeneca has moved elecoglipron into a Phase III program after the Lancet readout. Structure Therapeutics' aleniglipron, with its Nature Medicine publication this month, is the most advanced of the late-Phase-II small-molecule candidates. Viking Therapeutics presented 13-week Phase 2 data for its oral VK2735 at the European Congress on Obesity in 2026, and Ascletis reported a 7.7% placebo-adjusted body-weight reduction at 13 weeks for its ASC30 candidate in a US Phase II study, with the company flagging better gastrointestinal tolerability than peers. Roche's Genentech unit has separately reported positive Phase I results for an oral GLP-1 candidate, keeping the entry point crowded.
Three things still have to land before any of these Phase II numbers become a routine prescription. First, head-to-head data against once-weekly injectable semaglutide at full duration and approved doses; most of the 11–12% figures are 36-week dose-arm readouts, not full-trial primary endpoints, and tolerability comparisons are not standardized across sponsors. Second, dropout and discontinuation rates, since gastrointestinal side effects have been the main ceiling on real-world GLP-1 adherence and several of these candidates have signaled that ceiling but not yet broken it. Third, access. Oral GLP-1s will inherit the same pricing, insurance, and supply questions that already shape the injectable market, and a cheaper-to-make pill does not automatically translate into a cheaper-for-the-patient pill.
The split now visible between peptide-plus-SNAC and small-molecule candidates is, in practice, a bet on which company can scale what kind of chemistry to a billion-patient demand. The Phase III readouts already announced for elecoglipron will be the next data points that test which side of that bet converts the weekly shot into a daily pill.