Overview
The race is shifting from how much to what kind of weight patients lose. These nine companies are building on what Ozempic started, betting on pills instead of injections, drugs that spare muscle, and uses well beyond obesity.
Ozempic proved that patients could experience serious weight loss, and it did so fast enough that the debate over whether these drugs worked ended within a few years. What drugmakers are arguing about now is what kind of weight comes off, whether patients are losing fat or muscle, and what other benefits could be gained from these drugs.
The market is well established. The global GLP-1 market was valued at $52.82 billion in 2025 and is projected to reach $133.92 billion by 2034, growing at 10.9 percent annually.
Karl Nadolsky, DO, Assistant Clinical Professor at Michigan State University College of Human Medicine and Director of the Endocrine Clinic at the Gym, says there is a paradigm shift toward the quality and kind of weight loss versus a focus on the amount of weight lost.
"Beyond the obvious body composition perspective, what actually matters is reducing the risk of obesity-related disease and complications, as we prioritized in our 2025 AACE Clinical Practice Algorithm," he says.
Many of the cardiovascular, renal, and hepatic benefits of semaglutide, sold as Ozempic and Wegovy, appear to occur independently of weight loss or glucose improvement, he notes.
"Perhaps doses that achieve modest weight loss but robust anti-inflammatory and vascular benefits might be appropriate for some indications, while maximum-tolerated doses remain appropriate for obesity," says Nadolsky. "This concept could reshape how GLP-1RAs are prescribed across different disease states."
The field is evolving in four directions at once: oral formulations, multi-agonist combinations, muscle preservation strategies, and expansion into disease areas beyond metabolic medicine.
"Muscle preservation is emerging as a critical co-development priority," says Nadolsky. Lean mass loss with GLP-1 medicines is generally proportional to total weight lost, about 25 to 30 percent, similar to other weight-loss interventions, and physical function and quality of life improve. Nadolsky says this is clinically concerning in older or sarcopenic populations.
"Several pharmacologic strategies are now in clinical trials, though people still need to include strength training," he says.
The muscle question is the nearest-term one. The more speculative work is happening outside metabolic medicine entirely. CNS and neuropsychiatric applications are the most speculative frontier and potentially the highest impact. Preclinical data consistently show neuroprotective effects, though the dedicated EVOKE trial of semaglutide for Alzheimer's disease found no significant benefit. Nadolsky says results in Parkinson's disease are more encouraging. Three trials with short-acting GLP-1RAs, exenatide and lixisenatide, showed slowed motor decline, though longer-acting formulations have not replicated this.
"The field is also exploring migraine, intracranial hypertension, inflammatory bowel disease, psoriasis, and rheumatoid arthritis, all out of my wheelhouse," he says.
Substance use disorders are generating particularly compelling signals. Starting a GLP-1RA appears associated with reduced risk of incident alcohol use, and possibly reduced opioid, cocaine, and nicotine use.
Can Smaller Companies Make It in the GLP-1 Market?
Nadolsky sees room for smaller companies to differentiate, even with the bar set extraordinarily high.
"Semaglutide is the most validated GLP-1 medicine in outcomes trials, with demonstrated benefits across atherosclerotic CVD, HFpEF, CKD, MASH, OSA, and osteoarthritis," he says.
According to him, the most credible differentiation strategies include:
Novel receptor pharmacology: Ecnoglutide's biased agonism produces markedly lower rates of GI side effects and discontinuation.
Dosing convenience: MariTide, from Amgen, uses once-monthly subcutaneous dosing rather than weekly injections.
Indication-specific advantages: Glucagon co-agonists such as survodutide, mazdutide, and retatrutide may have superior hepatic effects in MASH and MASLD because glucagon acts directly on liver lipid metabolism.
Combination with muscle-preserving agents: Companies developing myostatin and activin pathway inhibitors alongside GLP-1RAs are addressing a real unmet need that Novo Nordisk and Eli Lilly are also pursuing but have not yet solved.
"This could create a niche where these agents outperform pure GLP-1RAs," says Nadolsky.
That said, the established therapies and pipeline from Novo Nordisk and Eli Lilly are formidable, he adds.
"Smaller players will likely need to demonstrate either superior tolerability, novel indication-specific efficacy, meaningfully different dosing convenience, or combination strategies that address limitations of current agents, particularly muscle loss, rather than simply competing on weight-loss magnitude alone," says Nadolsky.
Below are nine companies finding their place in the GLP-1 market.
Viking Therapeutics
Sector: Dual and triple agonists for obesity, metabolic, and liver disease
HQ: San Diego, CA
Year Founded: 2012
Origin Story: The company built its pipeline around small molecule and peptide candidates licensed from academic and pharma sources, eventually advancing VK2735, a dual GLP-1/GIP receptor agonist designed to be the first such therapy available in both oral and injectable formulations.
Key Leaders: Brian Lian, PhD, President & CEO; Marianna Mancini, COO; Greg Zante, CFO; Hubert C. Chen, MD, Chief Medical Officer
Number Of Employees: ~59
Stage: Publicly traded
Financial Snapshot:The company’s market cap as of July 2026 is $4.39 billion
Key Products: VK2735 (subcutaneous), dual GLP-1/GIP receptor agonist in ; VK2735, same dual agonist in pill form; VK3019, novel amylin receptor agonist for obesity; VK2809, oral thyroid hormone receptor beta agonist for MASH; VK0214, oral TRβ agonist for X-linked adrenoleukodystrophy (X-ALD)
Recent Highlights: In June 2026, Viking announced that its working toward maintenance-dosing data for subcutaneous VK2735 and preparing to start Phase 3 trials of the oral tablet in Q4 2026, with the goal of becoming the first company to offer a dual GLP-1/GIP agonist in both oral and injectable form.
Structure Therapeutics
Sector: Oral small molecule GLP-1 receptor agonists for obesity
HQ: San Francisco, CA
Year Founded: 2016 (as Eccogene; renamed Structure Therapeutics in 2021)
Origin Story: Founded by Raymond Stevens, PhD, a structural biologist renowned for his work decoding G protein-coupled receptor (GPCR) structures. (source)
Key Leaders: Raymond Stevens, PhD, Founder & CEO; Blai Coll, MD, Chief Medical Officer; Xichen Lin, PhD, Chief Scientific Officer; Yingli Ma, PhD, Chief Technology Officer
Number Of Employees: ~233
Stage: Publicly traded
Financial Snapshot:The company’s market cap was $3.41 billion as of July 2026.
Key Products: Aleniglipron (GSBR-1290), a once-daily oral, nonpeptide small molecule GLP-1 receptor agonist; Oral amylin program in combination with aleniglipron; Oral metabolic franchise, a broader portfolio of oral small molecule candidates targeting metabolic disease beyond the lead GLP-1 program
Recent Highlights: In May 2026, Structure reported positive end-of-Phase 2 feedback from the FDA for aleniglipron, clearing the way to begin a Phase 3 registrational program for chronic weight management in Q3 2026. CEO Raymond Stevens has emphasized that aleniglipron's manufacturing scalability and its combinability with other therapies, including an oral amylin candidate and PCSK9 inhibitors, differentiate it from injectable incumbents.
Altimmune
Sector: Dual GLP-1/glucagon receptor agonists for obesity and liver disease
HQ: Gaithersburg, MD
Year Founded: 1997
Origin Story: Altimmune originally focused on infectious disease vaccines and biodefense, including a formative all-stock merger with PharmAthene, a US biodefense drug specialist. Over the past several years, the company repositioned entirely around pemvidutide, its balanced dual GLP-1/glucagon receptor agonist for obesity and liver disease.
Key Leaders: Jerome Durso, President & CEO; Christophe Arbet-Engels, MD, Chief Medical Officer; Scot Roberts, PhD, Chief Scientific Officer
Number Of Employees: ~57
Stage: Publicly traded
Financial Snapshot:The company’s market cap as of July 2026 was $548 million.
Key Products: Pemvidutide, balanced 1:1 dual GLP-1/glucagon receptor agonist, designed to drive both appetite suppression (GLP-1) and direct hepatic fat oxidation (glucagon); Pemvidutide in MASH; Pemvidutide in alcohol use disorder; Pemvidutide in alcohol-associated liver disease (ALD)
Recent Highlights: In May 2026, the company announced that Pemvidutide demonstrated significant metabolic improvements in patients with MASH in new 48‑week IMPACT Phase 2b data.
MBX Biosciences
Sector: Precision Endocrine Peptide platform for obesity and rare endocrine disorders
HQ: Carmel, IN
Year Founded: 2018
Origin Story: MBX Biosciences is an Indiana University faculty-created startup founded by Peter Kent Hawryluk and Richard D. DiMarchi, scientists with a track record in peptide drug discovery. The company built its proprietary Precision Endocrine Peptide (PEP) platform to engineer peptide hormones with extended time-action profiles, aiming to overcome the dosing-frequency and tolerability limitations of earlier peptide therapeutics, including in the obesity space.
Key Leaders: Steve Hoerter, Chief Executive Officer; Sam Azoulay, MD, Chief Medical Officer; Karen Basbaum, Chief Business Officer
Number Of Employees: ~63
Stage: Publicly traded
Financial Snapshot:The market cap for July 2026 is $2.81 billion.
Key Products: Canvuparatide (MBX 2109), once-weekly parathyroid hormone peptide prodrug for chronic hypoparathyroidism; Imapextide (MBX 1416), long-acting GLP-1 receptor antagonist for post-bariatric hypoglycemia (PBH); MBX 4291, dual GLP-1/GIP co-agonist prodrug designed for potential once-monthly dosing and improved tolerability in obesity
Recent Highlights: In June 2026, MBX Biosciences announced data that demonstrated sustained benefit of its once-weekly Canvuparatide as a potential PTH replacement therapy in chronic hypoparathyroidism.
Rivus Pharmaceuticals
Sector: Oral muscle-sparing therapeutics for obesity and metabolic liver disease
HQ: Charlottesville, VA
Year Founded: 2019
Origin Story: Rivus Pharmaceuticals was founded around the science of mitochondrial uncoupling, a natural process by which the body dissipates energy by burning fat and sugar without the muscle loss associated with caloric restriction or appetite-suppressing drugs. The company’s Controlled Metabolic Accelerator (CMA) platform was designed from inception to address obesity’s primary driver while explicitly preserving skeletal muscle mass.
Key Leaders: Jorge Bartolome, CEO; Allen Cunningham, Co-Founder & Chief Operating Officer; Shaharyar Khan, PhD, Chief Scientific Officer
Number Of Employees: ~27
Stage: Private, Series B2
Financial Snapshot: Has raised $224M total across funding rounds, including a $132M Series B
Notable Investors: RA Capital Management; Bain Capital Life Sciences; BB Biotech AG; Longitude Capital; Medicxi; RxCapital
Key Products: HU6, oral Controlled Metabolic Accelerator (mitochondrial uncoupler); RV-8451, differentiated oral, muscle-preserving GLP-1 candidate for obesity
Recent Highlights: In February 2026, Rivus stated it was entering ‘a pivotal year,’ advancing HU6 in the AMPLIFY Phase 2 MASH trial while preparing the first clinical trial for RV-8451, its muscle-preserving oral GLP-1 candidate, designed to address the muscle-loss criticism leveled at existing GLP-1 therapies.
Aardvark Therapeutics
Sector: Oral gut-restricted bitter taste receptor agonists for hunger suppression
HQ: San Diego, CA
Year Founded: 2017
Origin Story: Aardvark Therapeutics was founded around a mechanistically distinct hypothesis: rather than suppressing appetite like GLP-1 drugs, the company’s lead compound activates bitter taste receptors (TAS2Rs) confined to the gastrointestinal tract to trigger local release of satiety hormones, targeting hunger itself without systemic drug exposure.
Key Leaders: Tien Lee, MD, Founder & CEO; Manasi Jaiman, MD, Chief Medical Officer; Nelson Sun, Chief Financial Officer & Chief Operating Officer; Tim Kieffer, PhD, Chief Scientific Officer
Number Of Employees: ~40
Stage: Publicly traded
Financial Snapshot:The company’s market cap was $126.7 million as of July 2026.
Key Products: ARD-101, oral, gut-restricted small-molecule TAS2R agonist; ARD-201, planned fixed-dose combination of ARD-101 with a DPP-4 inhibitor for obesity; WE-868, a earlier-stage/preclinical isoflavonoid modulator of oxidative metabolism
Recent Highlights: In May 2026, Aardvark announced that the U.S. Food and Drug Administration placed a full clinical hold on its investigational new drug application for ARD-101 related to the Company’s previously announced voluntary pause.
Septerna
Sector: GPC Septerna R-targeted oral small molecule drug discovery, including GLP-1, GIP, and glucagon receptors
HQ: South San Francisco, CA
Year Founded: 2019 (under the name GPCR NewCo, Inc.); 2021 (became Septerna)
Origin Story: Septerna is co-founded by Robert Lefkowitz, a Duke University biochemist who won the 2012 Nobel Prize in Chemistry for his work decoding G protein-coupled receptors (GPCRs). The company built its proprietary Native Complex Platform to isolate and reconstitute GPCRs outside of cells in formats that mimic their natural structure.
Key Leaders: Jeffrey Finer, MD, CEO & Co-founder; Liz Bhatt, MS, MBA, President and COO; Gil Labrucherie, CFA, JD, Chief Financial Officer; Daniel Long, DPhil, Senior Vice President of Drug Discovery
Number Of Employees: ~130
Stage: Publicly traded
Financial Snapshot:The company’s market cap as of July 2026 was $1.49 billion.
Key Products: SEP-631, an oral small-molecule negative allosteric modulator (NAM) targeting the MRGPRX2 receptor; SEP-479 oral small-molecule agonist of the parathyroid hormone 1 receptor (PTH1R) aimed at treating hypoparathyroidism
Recent Highlights: In May 2025, Septerna signed an exclusive global collaboration with Novo Nordisk worth up to $2.2B to co-develop oral small molecule GLP-1, GIP, and glucagon receptor agonists. Septerna’s preclinical data showed that combining its oral GIP receptor agonist with semaglutide produced tirzepatide-like weight loss in mice.
Eli Lilly
Sector: Oral and injectable incretin therapeutics for obesity and diabetes
HQ: Indianapolis, IN
Year Founded: 1876
Origin Story: Colonel Eli Lilly, a pharmaceutical chemist and former Union Army officer founded the company to manufacture medicines including the world’s first commercially available insulin product. More than a century later, the company became a leader in incretin biology, building the GLP-1/GIP dual agonist tirzepatide (Mounjaro/Zepbound) and following it with retatrutide and orforglipron, its oral non-peptide GLP-1 program.
Key Leaders: David A. Ricks, Chair and CEO; Daniel Skovronsky, MD, Chief Scientific & Product Officer & President
Number Of Employees: ~50,000
Stage: Commercial and late clinical-stage; large-cap
Financial Snapshot:The company’s market cap was about $1 trillion as of July 2026.
Key Products: Orforglipron (Foundayo), is first oral GLP-1 receptor agonist developed by the company that can be taken at any time of day; Retatrutide, investigational triple agonist of GLP-1, GIP, and glucagon receptors; Mounjaro/Zepbound (tirzepatide), approved dual GLP-1/GIP agonist for type 2 diabetes and obesity
Recent Highlights: In April 2026, the FDA approved orforglipron (Foundayo), making it one of the first oral GLP-1 pills that can be taken any time of day and that has no food or water restrictions. Lilly is racing to file orforglipron for type 2 diabetes in 2026 while advancing retatrutide toward what could be the most efficacious obesity therapy yet studied.
Regeneron Pharmaceuticals
Sector: Muscle-preserving antibody combinations and GLP-1 therapy for obesity
HQ: Tarrytown, NY
Year Founded: 1988
Origin Story: Founded in 1988 by Leonard Schleifer, MD, PhD, a neurologist and assistant professor at Cornell University Medical College on the premise that drug discovery could be industrialized through proprietary antibody-generation technology. The company’s entry into obesity combines this antibody expertise with GLP-1 biology, however, its focus is testing whether muscle-preserving antibodies, including trevogrumab, a myostatin inhibitor, can be combined with semaglutide to address the lean-mass loss associated with GLP-1 monotherapy.
Key Leaders: Leonard S. Schleifer, MD, President & CEO; George D. Yancopoulos, MD, Board Co-Chair, President & Chief Scientific Officer
Number Of Employees: ~15,400
Stage: Public
Financial Snapshot:The company’s market cap as of July 2026 was $70.54 billion.
Key Products: Trevogrumab, anti-myostatin antibody designed to preserve lean muscle mass that was tested in combination with semaglutide to offset GLP-1-associated muscle loss; Garetosmab, activin A inhibitor antibody for muscle-preservation combination regimens in obesity
Recent Highlights: In June 2026, the company announced it would present new clinical data from the Phase 2 COURAGE trial that examines the effects of trevogrumab (anti-GDF8) on lean mass in people with obesity treated with semaglutide. An additional abstract will provide early preclinical research on muscle biology.
