AstraZeneca presented VISTA Phase 2b data at ADA 2026 with simultaneous Lancet publication. In adults with obesity or overweight plus comorbidity, oral elecoglipron 75 mg produced 10.5% mean weight loss at 26 weeks versus 0.6% on placebo, continuing to 11.8% by 36 weeks, alongside blood-pressure and inflammation reductions. The companion SOLSTICE T2D trial showed 1.9-point HbA1c reductions with 90% reaching HbA1c under 7% and 7.7% weight loss. AstraZeneca announced an extensive Phase 3 program covering obesity, T2D, and cardiovascular and kidney outcome trials.
Novo Nordisk presented the full REIMAGINE 1/2/3 Phase 3 program in a Sunday symposium at ADA 2026, with simultaneous publication in The Lancet Diabetes & Endocrinology (REIMAGINE 1 and 2) and The Lancet (REIMAGINE 3). REIMAGINE 2 (n=2,713; 68 weeks) showed CagriSema 2.4/2.4 mg producing 14.2% weight loss and 1.91% HbA1c reduction versus 10.2% and 1.75% for semaglutide 2.4 mg alone. REIMAGINE 1 (n=189; 40 weeks) showed 13.8% weight loss and 1.8% HbA1c drop vs placebo. REIMAGINE 3 (n=274) showed 12.0% weight loss and a 2.33% HbA1c drop when added to basal insulin.
The first Phase 3 retatrutide diabetes trial, TRANSCEND-T2D-1, was simultaneously published in The Lancet and presented at the June 6 symposium. In adults with type 2 diabetes inadequately controlled on lifestyle alone, retatrutide produced A1C reductions of up to 2.0 percentage points and weight loss of up to 16.8% (36.6 lbs) at 40 weeks, with up to 46% achieving a normal A1C — a threshold rare in diabetes treatment trials. Systolic blood pressure and lipid markers improved across doses.
The Lancet formalized SURMOUNT-MAINTAIN on May 14, 2026, the same day the trial was presented at ECO 2026 in Istanbul. The Phase 3b 112-week study from Dr. Deborah Horn and colleagues at UTHealth Houston re-randomized patients who had reached maximum tolerated dose tirzepatide to continue MTD (15 mg or 10 mg), step down to 5 mg, or switch to placebo. Patients continuing MTD were 7x more likely to maintain their weight loss than those switching to placebo; the 5 mg step-down arm was 4x more likely than placebo. At week 112, MTD continuers preserved all of their initial weight loss; 5 mg-step-down patients lost only 5.6 kg of their initial gains on average. The 'seven times more likely' framing — picked up by EurekAlert and the daily science press — is the cleanest patient-facing summary of maintenance economics published to date.
The Lancet's 'Making Treatment for Obesity More Equitable' editorial (March 2026) and an accompanying medRxiv preprint (Hill et al., March 4, 2026) synthesized 2024-2025 active pharmaceutical ingredient shipment data to estimate generic semaglutide production costs at $28-140/person-year for injectable formulations and $186-380/person-year for oral formulations. By the end of 2026, generic injectable semaglutide could be available in 160 countries covering 69% of global T2DM and 84% of clinical obesity. The 10 countries where Novo Nordisk's 2026 patents expired represent 44% of the global population and 48% of the global obesity burden — including Brazil, Canada, China, India, and Turkey. The constraint isn't manufacturing economics; it's device-patent thickets (57% of analyzed semaglutide patents are device patents) and policy coordination (pooled procurement, voluntary licensing, tiered pricing).
Eli Lilly published SURMOUNT-MAINTAIN in The Lancet and ATTAIN-MAINTAIN in Nature Medicine on May 12, with concurrent presentation at ECO 2026 in Istanbul. SURMOUNT-MAINTAIN tested lower-dose Zepbound (tirzepatide 5 mg) vs maximum tolerated dose: at week 112, MTD preserved all weight loss while the 5 mg arm lost only 5.6 kg additional. ATTAIN-MAINTAIN tested Foundayo (orforglipron) as a switch from injectable GLP-1s in SURMOUNT-5 participants: orforglipron preserved 79.3% of injectable-phase weight loss vs 37.6% on placebo at week 52; Wegovy MTD switchers regained only 0.9 kg, Zepbound MTD switchers regained 5.0 kg. The dual readout reframes the maintenance-versus-discontinuation conversation: dose-tapering and oral-switching strategies now have Phase 3 evidence behind them, validating the long-term-treatment chronic-disease framing.