The sprint to the finish for orforglipron is picking up pace with a pivotal trial in obesity and diabetes published yesterday in The Lancet. Things are looking good for this relatively simple GLP-1 agonist in a tablet. The presentation of these results from ATTAIN-2 were a highlight of ObesityWeek earlier this month, but having this publication with peer review lends confidence.

In sum, orforglipron delivered good outcomes on all prespecified measures of weight and cardiometabolic health. The safety profile is similar to other GLP-1s. Treating obesity in persons with diabetes is a severe test and orforglipron clearly passed.

Deborah Horn, lead author of this new paper, describes the importance of these findings:

“We know it is harder for individuals with diabetes to lose weight. It is exciting to have an oral medication that provides double-digit weight loss, which on average was 23 lbs. Once FDA approved, orforglipron is scheduled to be available in 2026 at a significantly decreased cost compared to current injectables. This could position it to be the ‘metformin’ of obesity and become widely covered by insurance plans, opening the door to treatment for all.”

Aiming for Care at Scale

At this point, we cannot be sure if this particular medicine will be a roaring success or just one more option. The real proof will come in clinical use.

But the attention lavished on orforglipron points to a real unmet need for obesity care at scale. Industry analysts anticipate orforglipron playing a key role for delivering that care to a much broader population. In a report from Truist Financial, they say:

“We note that the obesity market is highly elastic with higher volumes of patients tending to stay on drug for longer periods of time given lower price points.

“We anticipate rapid uptake and significant expansion of the obesity market once the oral pill has been approved.”

With a Commissioner’s National Priority Voucher for orforglipron already in hand, Lilly could be in a position to launch the drug early next year. Then, and only then, we will see if this new option really does open up access to obesity care for a much larger population of people who need it.

Click here for the study in Lancet, here, here, and here for further perspective.

Finish Line, photograph by Mike Boswell, licensed under CC BY 2.0