A new daily pill has helped people lose more than 10 per cent of their body weight within six months, according to the results of two Phase II trials published in The Lancet.
The drug, elecoglipron, developed by AstraZeneca, is an oral small-molecule GLP‑1 receptor agonist. In the Vista trial, which enrolled more than 300 adults who were overweight or obese but did not have type 2 diabetes, the highest tested dose of 75 mg led to an average weight reduction of 10.5 per cent at 26 weeks, compared with 0.6 per cent in the placebo group. Weight loss continued progressively, reaching 11.8 per cent at 36 weeks, with researchers noting that “the sustained reduction in bodyweight up to 36 weeks without evidence of a plateau suggests that maximal weight loss might not have been reached by six months”.
Up to 88.8 per cent of participants taking the 75 mg dose achieved at least 5 per cent weight loss by 26 weeks. The trial also recorded clinically meaningful reductions in blood pressure and levels of C‑reactive protein, a marker of systemic inflammation. “Despite huge progress in the field of obesity management, significant opportunity remains to deliver broader, sustainable and more meaningful health benefits for the billions of people living with obesity or weight-related complications,” said Professor Melanie Davies, a diabetes medicine expert at the University of Leicester, honorary consultant diabetologist at University Hospitals of Leicester NHS Trust and principal investigator for Vista. “The Vista results show that people receiving once‑daily oral elecoglipron achieved significant weight loss as well as lower blood pressure and systemic inflammation, demonstrating its potential to treat both obesity and its related complications.”
How the drug works
Elecoglipron belongs to the class of drugs known as GLP‑1 receptor agonists. These medicines mimic the action of the natural GLP‑1 hormone, which the body releases after eating. By activating GLP‑1 receptors, the drug stimulates the pancreas to produce more insulin, slows down the rate at which the stomach empties food into the small intestine, and acts directly on brain regions that regulate appetite. This combination of effects leads to reduced calorie intake and progressive weight loss over time.
A key advantage of elecoglipron is its form: a once‑daily tablet taken by mouth. Most existing GLP‑1 receptor agonists are given as injections, which can be a barrier for some patients. Moreover, elecoglipron does not require the fasting restrictions that apply to other oral weight‑loss medications, which often must be taken on an empty stomach at least 30 minutes before a meal. In the words of the Solstice trial investigators, “elecoglipron administration requires no food or fluid restrictions and could provide a convenient and accessible treatment option”.
AstraZeneca licensed the drug from Eccogene in 2023 for an initial payment of $185 million, with potential milestone payments reaching $1.8 billion. The company is now advancing elecoglipron into an extensive Phase III programme that includes the EMBOLD trials for obesity and overweight (with and without type 2 diabetes) and the ELUMINATE trials for type 2 diabetes as both monotherapy and in combination with dapagliflozin. Additional outcome trials will investigate long‑term cardiovascular and kidney health.
Potential for diabetes
The Solstice trial, involving 404 adults in the United States with a body mass index above 23 and type 2 diabetes, tested elecoglipron across eight treatment groups. At the 75 mg dose, patients achieved a statistically significant average reduction in HbA1c – a key measure of blood sugar control – of 1.9 percentage points from baseline at 26 weeks, compared with 0.2 points in the placebo group. The majority of treated participants reached guideline‑recommended glycaemic targets: 90 per cent achieved an HbA1c below 7 per cent and 85 per cent reached 6.5 per cent or lower.
Weight loss in the diabetes group averaged 7.7 per cent at 26 weeks, against 1.7 per cent for placebo. Nearly three‑quarters of those taking elecoglipron lost at least 5 per cent of their body weight after six months, compared with 20.2 per cent in the placebo group. Researchers noted that the amount of weight lost increased with higher doses over the 26‑week period.
The most common side effects reported across both trials were gastrointestinal issues – nausea, diarrhoea, constipation and vomiting – which were predominantly mild to moderate in severity. Adverse events leading to discontinuation were infrequent, and no liver safety signals were observed. Sharon Barr, executive vice president of BioPharmaceuticals R&D at AstraZeneca, said the findings give the company “confidence” as Phase III trials begin. “The progression of elecoglipron is an important step in delivering a differentiated weight management portfolio, offering monotherapies and combinations, designed to address the biological complexity of obesity and comorbidities that can be tailored to individual needs, enabling people to live healthier lives,” she said.