On the 8th local time, the American Diabetes Association (ADA 2026) annual scientific sessions wrapped up in New Orleans. While obesity was unquestionably the theme of this year's meeting, the rules of competition shifted. The question is no longer "Do you have a GLP-1?" but "Which GLP-1 is it?" The coordinates moved from "How much weight does it take off?" to "Which comorbidities does it tackle together?" and from "Once-weekly injections?" to "Can it be monthly?"
◇Beyond the "highest weight-loss rate" to sleep apnea… the next battlefield Eli Lilly and Company mapped out
The first to draw attention, as expected, was Eli Lilly and Company.
The company's retatrutide is a triple agonist that simultaneously stimulates the glucagon, GIP, and GLP-1 receptors, and it recently posted greater weight loss than any existing drug in a phase 3 trial. Over 80 weeks, it demonstrated up to 28.3% weight loss, and one-third of patients reached a normal weight with a BMI of 25 or lower.
What Lilly especially emphasized at this meeting was improvement in comorbidities rather than the weight-loss number. Symptoms of knee osteoarthritis and sleep apnea improved, and cardiovascular risk factors such as triglycerides and non-HDL cholesterol also decreased. The strategy reads as positioning it not as a "drug that only reduces weight" but as a "drug that tackles multiple diseases triggered by obesity."
Tolerability, however, proved a drag. In the 12 mg high-dose group, 11.3% discontinued due to adverse events, and 25.3% experienced vomiting. The weight-loss effect is overwhelming, but given that obesity treatment requires long-term use, tolerability is as important as efficacy in real-world prescribing.
U.S. investment bank William Blair analyzed that considering retatrutide's tolerability profile, its use may be limited mainly to patients with severe obesity. By contrast, zepbound (brand name in Korea: Mounjaro), which currently leads the market, is still expected to maintain an edge in the balance of efficacy and tolerability.
Shehroze Mahmood, an analyst at market research firm GlobalData, also acknowledged retatrutide's potential as a "game changer," but noted that market penetration could be limited because many patients and physicians are already accustomed to zepbound or Wegovy.
◇Tackling fatty liver and curbing muscle loss… Boehringer puts forward the "quality of weight loss"
C. H. Boehringer Sohn AG & Co. KG, which in-licensed rights from Denmark's Zealand Pharma and is conducting global development and commercialization, also reported meaningful data for survodutide.
Survodutide is a dual agonist that simultaneously stimulates the glucagon and GLP-1 receptors, with phase 3 trials underway in obesity alone and in patients with metabolic dysfunction–associated steatotic liver disease (MASLD) with fibrosis. Back in Apr., data showed a "Wegovy-level effect," with 16.6% weight loss over 76 weeks versus 3.2% with placebo.
At this meeting, additional analyses of body composition and liver fat were presented. Most of the weight loss with survodutide came from fat reduction, while even at the highest dose, muscle loss accounted for only 10.8% of the total change in body weight. Visceral fat fell by up to 34%, and liver fat by up to 63.1%, confirming body composition improvements.
In the liver-focused study, 84.2% of treated patients achieved a relative reduction of 30% or more in liver fat, and 61% returned to normal liver fat levels. In the placebo group, the figures were 24.3% and 5.7%, respectively. GlobalData projected that survodutide will reach blockbuster status in 2028.
But tolerability emerged here as well. The discontinuation rate due to gastrointestinal adverse events was 19% in the survodutide group—six times the 2.9% seen with placebo. As with Lilly's retatrutide, this is cited as an issue to be addressed during future commercialization.
◇Same GLP-1, different mechanism of action… China's Sciwind targets Wegovy
While Lilly and Novo Nordisk split the market, Chinese biotech companies are stepping up the chase. Sciwind Biosciences, in a Late-Breaking Abstract at this meeting, said its next-generation GLP-1 candidate ecnoglutide showed greater weight loss than Wegovy in a head-to-head study.
In a phase 2 trial of 163 patients with obesity at 17 research centers in China, both drugs were given once weekly at the same 2.4 mg dose. At week 20, weight loss was 12.8% with ecnoglutide versus 9.5% with Wegovy. The share of patients who lost 10% or more of their weight was also 74% versus 40%, nearly double.
Ecnoglutide targets the same receptor as existing GLP-1 receptor agonists, but it is designed as a "cAMP-biased GLP-1 receptor agonist" that selectively modulates intracellular signaling pathways. The company said these results are the first head-to-head data showing clinical superiority for this mechanism.
The reason this result is drawing attention has more to do with market logic than the figures themselves. In a market already established by Wegovy and zepbound, latecomers must demonstrate differentiation in head-to-head trials, not just similar efficacy, to gain a foothold.
HK inno.N holds the domestic rights to develop and commercialize ecnoglutide. After signing a licensing deal with Sciwind in 2024, HK inno.N has been conducting phase 3 trials in Korea for obesity and diabetes indications.
◇Long-acting formulations and quadruple agonists… K-bio bets on "differentiation"
While overseas big pharma competed with late-stage clinical data, Korean companies made their presence felt with long-acting formulations (G2GBIO, Inventage Lab) and next-generation multi-agonist strategies (Daewon Pharmaceutical and PharmUs BioScience).
G2GBIO, using its own drug-delivery platform, presented preclinical data indicating it can develop once-monthly subcutaneous formulations of Kargicema (semaglutide and cagrilintide) and zepbound (tirzepatide). Inventage Lab likewise presented preclinical results for once-monthly injections based on semaglutide and tirzepatide. Both companies are aiming to out-license their platform technologies rather than develop standalone new drugs.
Daewon Pharmaceutical and PharmUs BioScience introduced a strategy to develop a quadruple agonist that adds gastrin to GLP-1, GIP, and glucagon. It is a step more complex than Lilly's retatrutide (a triple agonist). Targeting not only weight loss but also improvements in pancreatic and liver function, the approach puts future clinical data in the spotlight as the variable that will determine competitiveness.
A global pharmaceutical company official said, "Just a few years ago, competition in obesity drugs hinged on how much more weight you could take off, but now, assuming similar levels of weight loss, the field is moving to a stage where you also have to demonstrate improvements in comorbidities, treatment convenience, and maintenance strategies."