China’s Incretin Wave, ADA on Deck
Week Of May 30 - June 5, 2026
Not much in the way of data this week, given that ADA 2026 (the big diabetes conference) is just starting. Novo (CagriSema), Lilly (retatrutide), Boehringer (survodutide), and Roche (CT-388) are all set to present Phase 3 results there. Interesting news from China: Hengrui’s GLP-1/GIP dual HRS9531 began enrolling a 9,262-patient cardiovascular outcomes trial, a large, multi-year study of the kind that has mostly been run by Western incretin makers like Novo and Lilly. In this week’s Trial Spotlight, I go into why a Chinese sponsor is taking on a giant trial like this. In the Mechanism Explained, I zoom out to how China went from fast-follower to a major source of the obesity drugs Western pharma now licenses, and why it would be a mistake to assume it stays a cheap supplier.
One interesting thing I was reading this week: this New York Times piece on China’s rising role in drug development is about cancer drugs rather than GLP-1s, but it fits this week’s theme closely. The oncology deals it describes are the leading edge of the same shift now happening in the obesity and metabolic pipeline, where Chinese assets, and the deal activity around them, are an increasingly large part of the story.
🔥 THIS WEEK’S KEY DEVELOPMENTS
Wegovy pill launches in the United Arab Emirates.
Novo Nordisk has launched the Wegovy pill (semaglutide tablets) in the United Arab Emirates, the first country outside the United States to make the oral therapy available. The approval is based on the OASIS 4 trial, where the 25 mg once-daily dose demonstrated a mean weight loss of approximately 17%. The Wegovy pill is also approved to reduce the risk of major adverse cardiovascular events (MACE) in adults with established cardiovascular disease and obesity or overweight.
Press | Trials: NCT05564117 | Mechanism: GLP-1 receptor agonist
Lilly, Novo, and rivals head to ADA 2026 with their headline obesity data.
At the ADA 2026 Scientific Sessions, Eli Lilly will present Phase 3 data for its triple-G agonist retatrutide, which previously demonstrated 28.3% weight loss over 80 weeks in the TRIUMPH-1 study. Novo Nordisk will present Phase 3 data for CagriSema, which showed 23% average weight loss at 84 weeks in the head-to-head REDEFINE-4 study. Other companies presenting data include Boehringer Ingelheim for survodutide (16.6% weight loss at 76 weeks) and Roche for CT-388 (22.5% placebo-adjusted reduction at 48 weeks).
Press | Mechanism: Multiple
Lilly, Boehringer scale back German investments over budget cuts.
Citing planned cuts to healthcare spending in Germany, Eli Lilly is halving its €2.3 billion investment in a new manufacturing plant for its GLP-1 drugs, Zepbound and Mounjaro. The facility will open as planned in 2027 but will operate at half the intended capacity and headcount. Boehringer Ingelheim also dropped its plans to invest €900 million in German infrastructure expansion for the same reason.
Press | Mechanism: GLP-1/GIP dual agonist
📰 PRESS
Biomea Fusion to evaluate icovamenib with semaglutide in obesity.
Press | Mechanism: menin inhibitor + GLP-1 RA
Biohaven targets obesity with muscle-preserving taldefgrobep alfa.
Press | Mechanism: myostatin blocker
💡 TRIAL SPOTLIGHT
China’s GLP-1/GIP Dual Goes for the Hardest Endpoint: Inside HRS9531’s 9,262-Patient Cardiovascular Trial
A landmark in the globalization of the obesity drug race began this week as a pivotal cardiovascular outcomes trial for a Chinese-origin GLP-1/GIP agonist officially started recruiting. The 9,262-patient, placebo-controlled trial (NCT07551492) will test whether HRS9531 can reduce major adverse cardiovascular events (MACE) in adults with established atherosclerotic cardiovascular disease. This is a massive, long-term bet for sponsors Jiangsu Hengrui and its ex-China partner Kailera Therapeutics, with treatment lasting up to five years and a final readout not expected until 2031. Committing to a MACE-endpoint CVOT, the most expensive and highest-stakes trial in metabolic medicine, signals a strategic shift for China-developed assets; it’s a clear play to compete directly with Western incumbents on the ultimate value proposition for obesity drugs. After all, proving a therapy prevents heart attacks and strokes is what elevates it from a weight-loss agent to essential cardiovascular medicine, and as we made the full case for why these mega-trials are table stakes back in January, this is the evidence payers and guidelines require for broad reimbursement. While separate Phase 3 data from China showed the drug, a dual agonist like tirzepatide, produced Zepbound-class weight loss of around 18%, this event-driven outcomes trial takes on the harder question of cardiovascular benefit, still unanswered for this drug. The move places HRS9531 (known as ribupatide ex-China) in the same arena as ongoing CVOTs for Lilly’s orforglipron and retatrutide and Amgen’s MariTide, representing the leading edge of a much larger wave of China-origin incretins aiming for the global market, a trend explored in this week’s Mechanism Explained.
ClinicalTrials.gov: NCT07551492 (HRS9531 ASCVD cardiovascular outcomes trial)
🔬 MECHANISM EXPLAINED
From Fast-Follower to Licensing Engine: How China Became a Source of the West’s Next Obesity Drugs (Example drugs: Ribupatide (HRS9531), UBT251, Mazdutide)
A decade ago, China primarily licensed Western drugs for its domestic market; today, it has become a primary source of next-generation obesity assets for Western pharma. This strategic reversal is powered by a combination of clinical speed, cost advantages, and inventive deal structures that are reshaping the global incretin pipeline. The scale of this outbound wave is striking, marked by multi-billion-dollar pacts like Novo Nordisk licensing a triple agonist from United Laboratories for up to $2 billion, Regeneron acquiring rights to a Hansoh dual agonist for a similar amount, and Madrigal buying into a CSPC oral GLP-1. The template was set by Hengrui’s deal for its dual agonist ribupatide, featured in this week’s Trial Spotlight; it licensed the asset to a new venture-backed company, Kailera, for up to $6 billion in milestones plus a 20 percent equity stake, a structure validated by Kailera’s record-setting $625 million IPO. This “NewCo” model fuses licensing with venture capital, letting Chinese firms generate compelling human proof-of-concept data quickly and cheaply, and de-risking the asset for Western partners willing to pay premium prices for clinically advanced molecules.
That machine carries real caveats. In obesity specifically, the work is still more differentiated fast-following than first-in-class invention; several China-origin orals are open derivatives of established mechanisms, and the novel-target breakthroughs in obesity remain largely Western. The model also faces headwinds, from geopolitical tension to proposed US legislation that could limit the FDA’s acceptance of China-generated clinical data for American approvals.
But reading “fast-follower” as a permanent label would be its own mistake, because the trajectory points up-market. The bargain era is closing fast: the average upfront on a Chinese licensing deal climbed by nearly 40% in a single year, and analysts have started saying plainly that China is no longer the bargain basement. The deal structures are maturing too. Pfizer’s recent oncology pact with Innovent left the Chinese company with US and European co-commercialization and profit-share rights on a third of the programs, an arrangement analysts are calling a new model rather than a simple sale of ex-China rights. China’s first-in-class evidence is still led by oncology rather than obesity, but it is mounting, and in obesity China granted the world’s first approval of a GLP-1/glucagon dual for weight management, mazdutide. The safer assumption is not that China stays a discount source of me-too molecules, but that it keeps climbing from supplier of de-risked fast-follows toward co-developer and originator.
🆕 NEWLY REGISTERED TRIALS (5 in last week)
BALANCE-DM2 Phase 3 study of Bofanglutide in adults with Type 2 Diabetes (Carnot Laboratories, n=374)
Trials: NCT07628985 | Mechanism: GLP-1 receptor agonist
HRS-7535 Phase III evaluating a novel oral small-molecule GLP-1RA for renal efficacy and safety in patients with Chronic Kidney Disease (Shandong Suncadia Medicine, n=3690).
[Oral Formulations | New Indications | Safety/Tolerability]
Trials: NCT07625774 (RENEW-CKD) | Mechanism: GLP-1 receptor agonist
Oral VRB-103 and Ecnoglutide Phase 1 trial investigating oral VRB-103 alone or combined with oral ecnoglutide (VRB-101) in adults with obesity or overweight (Verdiva Bio Dev Limited, n=336)
[Weight Loss/Efficacy | Oral Formulations]
Trials: NCT07628127 | Mechanism: oral amylin agonist (VRB-103), alone or with oral GLP-1 (ecnoglutide)
Semaglutide observational study tracking real-world weight loss outcomes in a massive cohort of adults (Novo Nordisk, n=35000)
[Weight Loss/Efficacy]
Trials: NCT07627074 (Observational) | Mechanism: GLP-1 receptor agonist
BALANCE-OBS Phase 3 head-to-head study comparing Bofanglutide (GZR18) to Semaglutide for overweight/obesity in Latin American adults (Carnot Laboratories, n=352)
[Weight Loss/Efficacy]
Trials: NCT07622810 | Mechanism: GLP-1 receptor agonist
This newsletter compiles publicly available information from press releases, news sources, and trial registries. Not investment advice.
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