GLP-1 pipeline 2026: survodutide, mazdutide, amycretin and CagriSema

Survodutide is a once weekly peptide developed by Boehringer Ingelheim with Zealand Pharma that activates the GLP-1 receptor and the glucagon receptor. The GLP-1 side suppresses appetite and slows the stomach; the glucagon side raises energy expenditure and drives fat oxidation in the liver, the same component that distinguishes retatrutide. The trade off is that glucagon on its own raises blood glucose, so the balance between the two activities has to be tuned.

It is in the phase 3 SYNCHRONIZE program for obesity, and it holds FDA breakthrough therapy designation in MASH, the liver disease formerly called NASH, on the strength of phase 2 liver data. Phase 2 obesity results reported weight loss in the high teens percent over 46 weeks at the top dose, with the curve not yet flat, and the usual GI side effects driving dropouts at faster escalation. Full phase 3 results had not been published as of October 2026. The liver indication may be where it lands first.

Mazdutide is also a GLP-1 and glucagon dual agonist, developed by Innovent under license from Lilly, and it is the one drug on this list that a regulator has already approved: China approved it for weight management in June 2025. Global phase 3 trials are running, and there is no US filing as of October 2026.

Its Chinese phase 3 program reported weight loss in the mid teens percent at 48 weeks at the higher dose, in a population with lower average body weight than the US trials, along with improvements in liver fat and blood pressure. The mechanism and side effect profile track survodutide's, with nausea and vomiting at escalation and a heart rate signal from the glucagon component. For a US buyer the practical status is unapproved and investigational.

Amycretin is Novo Nordisk's attempt to put the CagriSema idea into a single peptide. One molecule activates both the GLP-1 receptor and the amylin receptor, so it delivers the two satiety signals that cagrilintide plus semaglutide deliver as two injections. It exists in subcutaneous and oral forms, and the subcutaneous version is the one with the headline early data.

Phase 3 started in the first quarter of 2026. The phase 1 and 2 data that got it there were small studies, with the subcutaneous form reporting weight loss in the low twenties percent over 36 weeks in a small number of participants, which is a striking number for that duration and a tiny sample. Those are early phase figures and the phase 3 program will take years. Nothing about amycretin is available outside trials, and vendor listings using the name should be treated with particular suspicion given how new the molecule is.

CagriSema is two existing molecules, cagrilintide 2.4 mg and semaglutide 2.4 mg, given together once weekly, and it is the furthest along of the amylin based approaches. In the phase 3 REDEFINE 1 trial it produced about 20 percent weight loss at 68 weeks in adults with obesity, more than either drug alone, and REDEFINE 2 reported about 14 percent in people with type 2 diabetes. The cagrilintide page covers the component in detail.

The result landed in the same range as tirzepatide rather than clearly above it, which was read as a disappointment against expectations, and Novo has filed it for regulatory review. The cagrilintide and semaglutide stack page covers the version of this that exists on the grey market: two vials, escalated together, with the phase 3 numbers as the only data and none of it generated in people copying the protocol at home.

Retatrutide is Lilly's GLP-1, GIP and glucagon triple agonist, and it is the pipeline drug people know. Phase 2 reported about 24 percent weight loss at 48 weeks with the curve still falling. In 2026 Lilly reported positive topline results from the phase 3 TRIUMPH program, with TRIUMPH-1 showing about 28 percent average loss over 80 weeks at 12 mg, roughly 70 lb, and TRIUMPH-2 and 3 meeting their primary endpoints. Those are sponsor reported figures pending full publication.

Lilly said it plans to file for FDA approval in the first quarter of 2027, so approval is not expected before late 2027 at the earliest. The heart rate increase remains the extra safety signal versus tirzepatide. The phase 3 results explainer covers the data, the dosage chart covers the trial schedule, and retatrutide cost covers what the grey market charges in the meantime.

Orforglipron is the one entry that is no longer pipeline. The FDA approved it on April 1, 2026 as Foundayo for chronic weight management. It is a small molecule GLP-1 receptor agonist taken as a daily tablet, with or without food, and it is not a peptide at all. That matters for manufacturing, since small molecules scale in a way that lipidated peptides do not, and for the market, since a pill with no cold chain changes who can use a GLP-1 drug and what it costs to supply.

Its weight loss sits closer to the single agonist injectables than to tirzepatide or retatrutide, which is what a GLP-1 only mechanism predicts. Orforglipron vs injectable GLP-1 goes through the numbers and the trade offs. It is included here because it reframes the rest of the list: the injectables above now have to beat an approved pill on convenience as well as an approved injection on efficacy.

The table lines the six up. Stage and status are as of October 2026 and all of it moves; the retatrutide filing, the CagriSema review and the survodutide phase 3 readouts are the events most likely to change it over the next year.

Research vendors list retatrutide, cagrilintide, survodutide and mazdutide today, years ahead of any approval, because peptide sequences are published in patents and papers and any contract synthesis lab can attempt them. The vial that arrives is a powder with a vendor's label. It has not been through the manufacturer's process, it is not the material used in the trials, and there is no official reference standard for any of these molecules, so a COA compares the vial with whatever reference the testing lab happened to have.

The gamble has two layers. The first is identity and quantity: a 39 amino acid lipidated peptide is hard to make well, and a cheap vial may be underfilled, lower purity or a different molecule, which how to read a COA explains how to check for and how to buy peptides puts in context. The second is that even a perfect vial is an investigational drug with limited safety data, used without the monitoring the trials had. The glucagon containing drugs raise heart rate, the amylin containing ones cause injection site reactions and under eating, and none of them has a label to titrate by.

Someone deciding between these should know that tirzepatide and semaglutide are approved, labeled and, through a prescriber, verified, and that the pipeline drugs are a bet on both the chemistry and the biology. Our best peptides for weight loss page ranks the options on evidence rather than on headline percentages.