Beyond Wegovy and Zepbound: Three Pipeline GLP-1 Drugs That Could Reach Approval in 2026-2027

The US weight-loss drug market in early 2026 is dominated by Eli Lilly (Zepbound, Mounjaro, and now Foundayo) and Novo Nordisk (Wegovy, Ozempic, and the pending CagriSema). But the pipeline behind those four products is bigger than most patients realize. This article walks through the verified published evidence for the three most-watched late-stage challenger GLP-1 drugs that aren't being made by Lilly or Novo: survodutide (Boehringer Ingelheim / Zealand Pharma), maridebart cafraglutide (MariTide) from Amgen, and ecnoglutide from Sciwind (licensed to Pfizer for the Chinese market). All three have produced peer-reviewed phase 2 or phase 3 results and at least one has already received regulatory approval — in a non-US market. Here's what the actual data shows.

Why a non-Lilly, non-Novo pipeline matters for patients

For most of the GLP-1 era, patients have had two effective injectable choices (Wegovy and Zepbound) and one effective oral (now Foundayo). Pricing has been high, supply has been constrained, and the entire conversation about access has revolved around two manufacturers. A genuinely competitive pipeline matters because:

1. Three or four real injectable competitors with overlapping mechanisms produces price competition in a way two cannot.
2. Different mechanisms (e.g., GLP-1 + glucagon vs GLP-1 alone vs GLP-1 + amylin) give patients who don't respond to or tolerate one mechanism a meaningfully different second option, not just a slightly different molecule from the same family.
3. Non-US-headquartered programs (Boehringer in Germany, Sciwind in China) reduce the supply-chain risk concentration that has been a quiet contributor to the multi-year US shortage cycles.

1. Survodutide (Boehringer Ingelheim + Zealand Pharma)

Survodutide (BI 456906) is a glucagon receptor + GLP-1 receptor dual agonist developed by Boehringer Ingelheim in partnership with Zealand Pharma. It activates both the GLP-1 receptor (driving the standard appetite suppression and gastric emptying delay) and the glucagon receptor (driving increased energy expenditure and lipolysis). The glucagon arm is the same mechanistic addition that makes retatrutide's effect size larger than tirzepatide's — survodutide is a dual agonist version of that idea (without the GIP arm).

Phase 2 evidence

The phase 2 dose-finding trial (le Roux et al., Lancet Diabetes & Endocrinology 2024 [5]) tested multiple survodutide dose levels in adults with obesity. The headline result was up to ~19% mean weight loss at the highest dose at 46 weeks, with a roughly linear dose-response curve and a GI adverse-event profile broadly consistent with the GLP-1 class. The 19% magnitude is meaningfully larger than what semaglutide produces at the Wegovy dose and approximately matches what tirzepatide produces at 15 mg, supporting the case for moving directly to phase 3 with the higher doses.

Survodutide also has a separate phase 2 trial in MASH (the new name for NASH — metabolic dysfunction-associated steatohepatitis) published in NEJM 2024 (Sanyal et al. [6]), with positive liver-fibrosis and hepatic-fat results. This opens an additional indication path independent of obesity.

SYNCHRONIZE phase 3 program

Boehringer Ingelheim has launched the SYNCHRONIZE phase 3 program — three large registrational trials that together cover obesity in non-diabetic adults, obesity in adults with type 2 diabetes, and a long-term cardiovascular outcomes study:

• SYNCHRONIZE-1 (NCT06066515): obesity (BMI ≥30) or overweight (BMI ≥27 with comorbidities) in patients without type 2 diabetes. Baseline characteristics published in Diabetes, Obesity and Metabolism 2026 [4].
• SYNCHRONIZE-2 (NCT06066528): same inclusion criteria but in adults with type 2 diabetes (HbA1c ≥6.5%, <10%). Baseline characteristics also published in DOM 2026 [3].
• SYNCHRONIZE-CVOT: long-term cardiovascular outcomes trial in patients with established CV disease, chronic kidney disease, or major CV risk factors.

The SYNCHRONIZE-CVOT design is the most strategically important of the three because it positions survodutide for a SELECT-style cardiovascular indication if the trial reads out positive — that's the indication that has driven the most insurance coverage expansion for semaglutide. As of this writing, no SYNCHRONIZE trial has reported efficacy data; only baseline characteristics. We'll update this article when topline results are available.

2. Maridebart cafraglutide (MariTide, Amgen)

Maridebart cafraglutide — branded MariTide in Amgen communications — is one of the most mechanistically unusual entries in the late-stage pipeline. It is a once-monthly subcutaneous injection that combines a GLP-1 receptor agonist with a GIP receptor antagonist. That's the opposite of tirzepatide, which agonizes both GLP-1 and GIP. The rationale is that there is debate about whether GIP receptor agonism or antagonism produces better metabolic outcomes, and Amgen is testing the antagonist hypothesis at scale.

The other distinguishing feature is dosing frequency — once a month — which would be a meaningful real-world adherence advantage if the efficacy held up.

Phase 2 trial (NEJM 2025)

Jastreboff et al. published the full phase 2 results in NEJM in June 2025 [1]. Verified design and outcomes:

• Sample size: 592 participants (465 in the obesity cohort, 127 in the obesity + type 2 diabetes cohort)
• Doses tested: 140 mg, 280 mg, and 420 mg subcutaneously, given every 4 weeks or every 8 weeks, with and without dose escalation
• Duration: 52 weeks

At the highest dose, MariTide produced approximately 16% mean weight loss at 52 weeks in the non-diabetic obesity cohort and 17% in the T2D cohort. These are substantial numbers but slightly lower than the topline that some early Amgen guidance had suggested, and the stock dropped on the readout — a similar dynamic to the CagriSema REDEFINE 1 reaction. MariTide also produced an HbA1c reduction of up to 2.2% in the T2D cohort and across-the- board cardiometabolic improvements (waist circumference, blood pressure, hs-CRP, lipid panel).

Phase 3 program

Amgen has stated it expects to initiate phase 3 outcomes trials in atherosclerotic cardiovascular disease, heart failure, and obstructive sleep apnea in the 2025 timeframe. Phase 3 weight management trials are also planned. None have read out as of this writing.

3. Ecnoglutide (Sciwind / Pfizer)

Ecnoglutide is a biased GLP-1 receptor agonist developed by Sciwind Biosciences in China. The “biased” descriptor refers to a pharmacological property: ecnoglutide preferentially activates the cAMP signaling arm downstream of the GLP-1 receptor while producing less β-arrestin recruitment. The hypothesis is that cAMP-biased signaling produces the desired metabolic effects (insulin secretion, appetite suppression) with less of the β-arrestin-mediated effects associated with GI tolerability problems and possibly receptor desensitization. Whether biased agonism actually delivers better real-world outcomes is still an open scientific question, but the SLIMMER phase 3 trial gives us the first large-scale clinical answer.

SLIMMER phase 3 trial (Lancet Diabetes & Endocrinology 2025)

Ji et al. published the SLIMMER phase 3 results in Lancet Diabetes & Endocrinology in 2025 [2]. Verified design and outcomes:

• Sample size: 664 adults randomized across 36 medical centers in China
• Population: overweight or obesity, no type 1 or type 2 diabetes
• Doses tested: ecnoglutide 1.2 mg, 1.8 mg, 2.4 mg subcutaneously weekly vs volume-matched placebo
• Duration: 40 weeks (with extended analysis to 48 weeks)

At the extended 48-week timepoint, the highest-dose group averaged more than 15% weight loss. This puts ecnoglutide in the same effect-size band as injectable semaglutide 2.4 mg (Wegovy) — comparable, not superior. The headline story is therefore not that ecnoglutide is more effective than what's already on the US market, but that it's a credible non-Western, non-Lilly, non-Novo manufacturer producing a phase-3-validated Wegovy-class drug. That matters for global pricing competition and supply chain diversity.

Regulatory status and Pfizer licensing

Sciwind has filed ecnoglutide for approval in China for both type 2 diabetes and obesity. The drug received regulatory approval from China's NMPA for chronic weight management. In a separately announced 2026 agreement, Pfizer licensed the mainland China commercialization rights to ecnoglutide (marketed as Xianweiying in China), giving Pfizer its first GLP-1 commercial product after the company shut down its own internal danuglipron program. There is no US filing for ecnoglutide as of this writing, and a US-population phase 3 trial would likely be required for FDA approval given the Chinese-only enrollment in SLIMMER.

How the three pipeline drugs compare

For comparison with the approved and near-approved drugs: Wegovy −14.9%, Zepbound −20.9%, Foundayo −12.4%, CagriSema −22.7%, and retatrutide phase 3 readout −28.7% at the highest dose. The pipeline drugs in this article are clustering in the same effect-size band as the approved injectables, which means the differentiation will come from mechanism diversity, dosing frequency (MariTide's monthly schedule), and manufacturer/supply diversity, not from raw weight-loss magnitude.

What this means for patients in 2026 and 2027

1. None of these three are FDA-approved for obesity in the US yet. Survodutide and MariTide are in or entering phase 3; ecnoglutide has Chinese approval but no US filing. Patients should not expect to access any of them through US prescribers in the near term unless they are enrolled in a clinical trial.
2. Compounding pharmacies cannot legally compound drugs that are still investigational unless they are on an FDA bulk substances list, which none of these three are. Any “compounded survodutide” or “compounded MariTide” offered by a telehealth provider would be a regulatory red flag.
3. The competitive landscape for the existing approved drugs will get more interesting as phase 3 readouts arrive over the next 12-24 months. Pricing pressure on Wegovy, Zepbound, and Foundayo is likely to follow.
4. Mechanism diversity is the bigger near-term story. Patients who don't tolerate or don't respond to Wegovy, Zepbound, or Foundayo today will have meaningfully different mechanistic options to try in the second half of the decade.

Open questions

1. Will SYNCHRONIZE replicate the phase 2 19% number? Phase 3 trials in obesity often produce slightly smaller mean weight loss than phase 2 dose- finding work because of broader populations and longer duration. Survodutide's phase 3 magnitude is the single biggest open question for the non-Lilly/Novo pipeline.
2. Does monthly MariTide dosing actually improve adherence? Real-world adherence to weekly injectables drops sharply after the first 6 months. A monthly schedule should help, but the trial-to-real- world translation has not been measured.
3. Will ecnoglutide come to the US? Sciwind would need to either run a US phase 3 trial or partner with a US-headquartered company to clear FDA requirements. Pfizer's involvement on the commercialization side may shape this decision.

Related research

For the approved-drug landscape that these pipeline drugs are competing against, see our deep-dives on Foundayo (orforglipron), CagriSema, retatrutide, and the tirzepatide vs semaglutide head-to-head. For the cardiovascular outcomes evidence anchoring the existing standard of care, see our SELECT trial deep-dive. For pricing context, see our GLP-1 pricing index.