A new daily pill has helped people lose more than 10 per cent of their body weight within six months, according to trial results published in the Lancet. The experimental drug, elecoglipron, developed by AstraZeneca, produced “clinically meaningful and progressive weight loss” in adults who were overweight or obese.
Significant weight loss observed in trials
In the Vista phase II study, 310 participants from Australia, Canada, Germany, Japan, Taiwan, the UK and the US were given either different doses of elecoglipron or a placebo. All were overweight or obese but did not have type 2 diabetes. At the highest dose of 75mg, those taking the drug lost an average of 10.5 per cent of their body weight after 26 weeks, compared with 0.6 per cent in the placebo group. Weight loss continued to increase, reaching 11.8 per cent at 36 weeks, compared with 0.3 per cent for placebo. Researchers noted 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”.
The drug also led to improvements in cardiometabolic risk factors, including lower blood pressure and reduced levels of C-reactive protein, a marker of systemic inflammation. Up to 88.8 per cent of participants receiving elecoglipron in the Vista trial achieved at least 5 per cent weight loss at 26 weeks, compared with 15.6 per cent in the placebo group. In the separate Solstice trial, which involved more than 400 adults in the US with type 2 diabetes and a body mass index above 23, nearly three-quarters of those taking the drug lost at least 5 per cent of their body weight after six months, compared with 20.2 per cent in the placebo group.
Professor Melanie Davies, a specialist in diabetes medicine at the University of Leicester and principal investigator for Vista, said: “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. 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 elecoglipron works
Elecoglipron belongs to a class of drugs known as GLP-1 receptor agonists. It is an oral, small-molecule drug that mimics the natural GLP-1 hormone. By targeting receptors in the gut and the hypothalamus as part of the brain-gut axis, it stimulates insulin production, slows the digestive process and curbs appetite. The drug has a biased signalling profile and is designed to facilitate weight loss by reducing appetite and energy intake, decreasing gastric emptying and increasing insulin secretion.
A key advantage of elecoglipron is its administration as a once-daily tablet rather than an injection. Unlike some other weight loss medications, it does not require fasting or fluid restrictions. Many existing oral therapies must be taken on an empty stomach at least 30 minutes before eating, but elecoglipron can be taken without such constraints, offering a more convenient dosing option. Researchers noted that “elecoglipron administration requires no food or fluid restrictions and could provide a convenient and accessible treatment option for those living with type 2 diabetes”.
The most common side effects reported across both trials were gastrointestinal and of mild to moderate severity. In the Vista trial at the 75mg dose, nausea occurred in 55 per cent of participants (compared with 20 per cent on placebo), constipation in 41 per cent (6 per cent on placebo), diarrhoea in 35 per cent (25 per cent on placebo) and vomiting in 29 per cent (5 per cent on placebo). In the Solstice trial, the corresponding figures were nausea 37 per cent (3 per cent), constipation 29 per cent (4 per cent), diarrhoea 21 per cent (15 per cent) and vomiting 18 per cent (1 per cent). Adverse events leading to discontinuation were infrequent, and no liver safety signals were observed.
Potential for type 2 diabetes treatment
The Solstice trial, which included 404 adults with type 2 diabetes, found that elecoglipron was more effective than placebo at lowering blood sugar and helping patients lose weight. At the highest dose of 75mg, the drug achieved a clinically meaningful average reduction in HbA1c of 1.9 per cent from baseline at 26 weeks, compared with 0.2 per cent with placebo. The majority of participants reached guideline-recommended glycaemic targets: 90 per cent achieved an HbA1c of less than 7 per cent, and 85 per cent reached an HbA1c of 6.5 per cent or lower by 26 weeks. Hypoglycaemia was uncommon, with no serious adverse events or discontinuations attributed to it.
Elecoglipron is now advancing into an extensive phase III programme. AstraZeneca will run the EMBOLD trials to evaluate the drug for obesity or overweight, with and without type 2 diabetes, and the ELUMINATE trials to assess it as monotherapy and in combination with dapagliflozin (Farxiga) for type 2 diabetes. Additional outcome trials focusing on long-term cardiovascular and kidney outcomes are also planned. The company is exploring elecoglipron as a backbone for potential future combination therapies and is assessing its use in indications beyond diabetes and weight management.
The drug enters a rapidly growing market that includes Novo Nordisk’s oral semaglutide, approved for weight loss in December 2025, and Eli Lilly’s orforglipron, which received US approval in April 2026. AstraZeneca aims to differentiate its offering through the convenience of a daily oral tablet that does not require fasting. Dr Vanita Aroda of Brigham and Women’s Hospital said elecoglipron’s results showed its potential as an important treatment option for type 2 diabetes, with many patients reaching glycaemic targets. Dr Marie Spreckley of the University of Cambridge described the trials as well-conducted, providing early evidence for an oral GLP-1 receptor agonist and supporting continued clinical development.
Sharon Barr, executive vice president of bioPharmaceuticals research and development at AstraZeneca, said the findings give the company “confidence” as phase III trials get under way. “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.”
