The GLP-1 Scoville Scale - April 2026
What’s hottest in the GLP-1 pipeline right now
The Scoville scale measures spiciness of chili peppers. I’m adapting it here to rank the GLP-1 (and related) clinical programs that analysts, investors, and developers are watching most closely. This is a lay of the land in terms of what’s hot, what’s upcoming, and what the stock charts say about how the market is pricing these bets. I’ll update this periodically as the landscape shifts. Please let me know in the comments if this is at all useful/helpful. I’m aware of most of this from following closely, but I originally made this for me to see things more easily all in one place and thought I’d share it. This incorporates signals tracked in our database (glp1.bio1up.com), and I call those out along the way.
TIER 1: White Hot
1. Retatrutide (Eli Lilly) — GLP-1/GIP/Glucagon Triple Agonist
• Program: TRIUMPH (7+ Phase 3 studies), TRANSCEND
• Why #1: Best-in-class 28.7% weight loss at 68 weeks (TRIUMPH-4). Only triple agonist in Phase 3. TRANSCEND-T2D-1 just reported positive topline (Mar 19) - up to 16.8% weight loss + 2.0% A1C reduction. TRIUMPH-1 pivotal obesity readout expected H1 2026.
• In our DB: TRIUMPH-Outcomes CVOT has 10,000 patients enrolled (active, not recruiting). Seven TRIUMPH readouts expected throughout 2026.
• Watch for: A dysesthesia safety signal flagged in trial data.
2. Survodutide (Boehringer Ingelheim / Zealand) — GLP-1/Glucagon Dual Agonist
• Program: SYNCHRONIZE
• Why it’s hot: Single most anticipated dataset from a non-Lilly/Novo company. Phase 2 showed ~18.7% weight loss. SYNCHRONIZE-1 topline could drop any day (H1 2026). Also has FDA Breakthrough Therapy for MASH.
• In our DB: SYNCHRONIZE-CVOT shows 5,531 patients, active not recruiting.
• Bear case: 24.6% Phase 2 discontinuation from GI side effects - tolerability will make or break it.
3. CagriSema (Novo Nordisk) — Cagrilintide (Amylin) + Semaglutide
• Status: NDA filed Dec 2025, PDUFA ~October 2026
• The problem: REDEFINE 4 (reported Feb 23 in our DB) - CagriSema failed non-inferiority vs Zepbound. REDEFINE 1 showed 22.7% vs placebo. In the head-to-head REDEFINE 4, CagriSema came in at 23.0% vs tirzepatide’s 25.5%. Novo now planning high-dose CagriSema Phase 3 to close the gap.
• In our DB: REDEFINE 3 has 7,101 patients (active, not recruiting). REIMAGINE 4 (CagriSema vs tirzepatide in T2D, 1,000 patients) had a minor date push to April 2026.
TIER 2: Very High Heat
4. Amycretin / Zenagamtide (Novo Nordisk) — Unimolecular GLP-1/Amylin
• 22% weight loss at just 36 weeks (Phase 1b/2a) - highest single-molecule early data. Oral version showed 13.1% at 12 weeks. Phase 3 enrollment began Q1 2026.
• Novo’s most important next-gen asset. Single molecule vs CagriSema’s two-component mix.
5. CT-388 (Roche/Carmot) — Signal-Biased GLP-1/GIP Dual Agonist
• 22.5% weight loss at 48 weeks (Phase 2, Jan 2026). Phase 3 ENITH-1/2 initiating. Combo Phase 2 with petrelintide starting H1 2026.
• Validated Roche’s $2.7B Carmot acquisition. The petrelintide combo could yield >30% weight loss.
6. PF-08653944 / MET-097 (Pfizer/Metsera) — Monthly GLP-1
• In our DB: 3,500 patients enrolling, primary completion Sep 2027.
• 12.3% weight loss at 28 weeks with monthly dosing (VESPER-3 Phase 2b). Full data at ADA June 2026. Massive 10-trial Phase 3 program (VESPER) ramping up.
• Only monthly-dosed GLP-1 in Phase 3. Backs Pfizer’s >$10B Metsera acquisition.
7. Petrelintide (Zealand / Roche) — Long-Acting Amylin Analog
• In our DB: ZUPREME positive Phase 2 reported Mar 5 - 10.7% weight loss with near-zero GI side effects (0% vomiting at max dose).
• Phase 3 mono and combo (with CT-388) both initiating 2026. The tolerability profile makes it the ideal combination backbone.
TIER 3: High Heat
8. VK2735 (Viking Therapeutics) — GLP-1/GIP Dual Agonist
• Just happened in our DB: VANQUISH-2 (1,100 patients) moved from RECRUITING → ACTIVE_NOT_RECRUITING on Apr 7 - enrollment complete!
• SC Phase 2: 14.7% at just 13 weeks. VANQUISH-1 (4,500 patients) data expected H2 2026/early 2027. Frequent acquisition target speculation.
9. MariTide / Maridebart Cafraglutide (Amgen) — Monthly GLP-1 Agonist / GIP Antagonist
• In our DB: MARITIME-CV is one of the largest trials we track at 12,800 patients (recruiting). MARITIME-HF at 5,056.
• Up to 20% weight loss at 52 weeks (Phase 2). Unique mechanism - GIP antagonism (opposite of tirzepatide). ADA June 2026 presentations expected.
10. Aleniglipron / GSBR-1290 (Structure Therapeutics) — Oral Small-Molecule GLP-1
• In our DB: ACCESS data updated Mar 16 - 16.3% weight loss at 44 weeks (180 mg). Advancing to Phase 3.
• Highest oral GLP-1 weight loss data reported. Competitive with some injectables.
11. Eloralintide + Tirzepatide (Eli Lilly) — Amylin + GLP-1/GIP Combo
• In our DB: 1,980 patients recruiting, primary completion Mar 2028.
• Combo showed 11.3% at just 12 weeks. Lilly’s answer to CagriSema.
Recently Approved (Landscape Shifters)
• Orforglipron / Foundayo (Lilly): FDA approved Apr 1 - first oral small-molecule GLP-1. ACHIEVE-3 in our DB (Feb 26) showed it beat oral semaglutide.
• Oral Wegovy 25 mg (Novo): Approved Jan 2026 at $149/month.
• Wegovy HD 7.2 mg (Novo): Approved Mar 19 - 20.7% weight loss, closing the tirzepatide gap.
Five Themes Shaping the Landscape
1. Amylin is the mechanism of the moment - CagriSema, amycretin, eloralintide, petrelintide, ABBV-295 all leverage amylin signaling. The thesis: amylin + GLP-1 combos push past 25-30% weight loss.
2. The oral convenience war is heating up - Orforglipron (approved), oral Wegovy (approved), aleniglipron (16.3%), VK2735 oral, elecoglipron. ATTAIN-MAINTAIN data reframes orals as maintenance therapy after injectable-driven loss.
3. Monthly dosing enters Phase 3 - Pfizer’s PF-08653944 and Amgen’s MariTide differentiate on dosing convenience.
4. Triple agonism’s defining year - Retatrutide’s TRIUMPH readouts will determine whether GLP-1/GIP/glucagon is truly best-in-class. 28.7% is the number to beat.
5. Quality of weight loss emerges - Regeneron’s COURAGE (anti-myostatin preserving 92.6% fat-only loss), bimagrumab + semaglutide (Nature Medicine, Mar 2), pemvidutide (78% fat loss). Lean mass preservation is becoming a competitive axis.
This newsletter compiles publicly available information from press releases, news sources, and trial registries. Not investment advice.
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