Beyond weight loss: What’s next for GLP-1s in 2026 and beyond

Luyi Guo: We have two important developments this year. First is the launch of the two oral versions of GLP-1s in the form of Wegovy^® pill and in the form of Foundayo™, which were launched both in January and April this year. And that really opens up the market for a lot more new patients. We have noticed, even though early in the days, about 80% of the people who get those prescriptions of oral GLP-1s are not previously treated by injectables. And the other important thing is more in the access. In Medicare, we will start to have this [GLP-1] Bridge Program to get reimbursement for our seniors for a lot of those weight loss management.

What is the most important benefit from GLP-1s that people are underestimating?

Luyi Guo: The biggest underestimation is people underestimate the multiple impacts of multiple body organs of the GLP-1 class, and also the multiple biomarkers, multiple diseases and symptoms that will impact. So let me just talk a little bit about multiple organs that we can run through. Cardiovascular risk reduction, heart failure risk reduction, impact on the kidney to reduce the possibility of kidney failure and slow down that decline of kidney, impact on fatty liver disease, impact on symptom relief for the pain of osteoarthritis of the knee, symptom relief of obstructive sleep apnea. The list goes on and on.

Beyond Type 2 diabetes and weight loss, where do you see the most credible next areas of impact?

Luyi Guo: One thing that is new and that’s started to be studied are neuroscience areas. So, for example, substance abuse, alcohol-use abuse, and we have anecdotal evidence to show that GLP’1s kind of tone down the noise, not just the food noise, but also those urges of substance abuse. So that’s a really interesting area to study. And there are phase 3 trials that just started, and I’m just very eager for our society, and for everybody, to learn whether we can prove those are really beneficial. And another area where we are seeing some early reports of the data already is if you combine the GLP-1s with treatment for immunology, to improve the outcomes, to improve the outcomes to treating psoriatic diseases such as psoriasis, psoriatic arthritis, and maybe potentially in the future other autoimmune diseases.

We will have more classes of GLP-1s, or even other mechanisms of action. Just to give a little sneak peek, we are on the cusp of three more approvals that are coming, I think, within the next one year. Two more dual agonists and one triple agonist that you will be starting to hear about that could impact differently for people, including improving the amount of weight loss, improving the impact on liver, et cetera. And we have even more classes [of weight-loss and diabetes medications] coming, such as amylin, which we can get into later. And that’s especially useful for people who may not tolerate GLP-1. It’s a small group of people who don’t tolerate, and this could be a very promising class, as well as in combination use of GLP-1s.

What does the evidence say about the link between GLP-1s and cardiovascular health?

Luyi Guo: The GLP-1s originally treated for type 2 diabetes. There’s more than half a dozen studies to show that they already, in the diabetes population using GLP-1s, they reduced the risk of developing cardiovascular events, which we call MACE – major adverse cardiovascular events – such as stroke, heart attack, cardiovascular deaths, getting hospitalized for those events, et cetera. And in the SELECT study, which is very important, that came out recently for semaglutide in the non-diabetes obese population. That study was very large, and it was presented at the American Heart Association. And what it showed was taking semagutide for this population, it really reduced the risk, cardiovascular risk, by 20%. And it reduced overall mortality, overall risk of dying, by roughly 20%, too – by 19%.

What excites you most about the next chapter for GLP-1s? What’s one thing that you think the market still underappreciates?

Luyi Guo: The good news is that we will have a lot more products, a lot more new mechanisms, to help different people to stay on this class of drugs that we already talked about. We have three new dual- and triple-agonists coming. And we will have drugs that have longer durations, maybe monthly dosing, that will help people maintain. And you can imagine the oral drugs can help some people who go from injectables to orals to maintain, or vice versa. Some people might start with orals and maintain on injectables. The new amylin class I’m very excited about that’s already in late-stage trials. That could potentially be used independently as a monotherapy for weight management, but also in combination with the GLP-1s that we know today.

If you look around the world, the WHO (World Health Organization) said there are almost 800 million people in the world that would benefit from this new class of weight loss drugs. And right now we are treating just more than tens of millions, I would say, in the world, so we are looking at hundreds of millions of patients, all populations, that can benefit from this class. And outside the United States, people are equally interested in this, equally taking a lot of interest in managing their own health.