The Next GLP-1 Pills: Elecoglipron, Aleniglipron and Other Oral Drugs in Trials

Two GLP-1 pills for weight loss are already approved in the US: Foundayo (orforglipron) and the Wegovy pill (oral semaglutide). Behind them is a wave of new daily tablets, most of them small molecules like orforglipron rather than peptides like semaglutide. In 2026 the first big trials of several were published: elecoglipron (up to −10.5% at 26 weeks), aleniglipron (up to −11.3% placebo-adjusted at 36 weeks), and Chinese candidates HRS-7535, VCT220 and safiglipron.^{[1][3][4][5][6][7]} Another, TERN-601, was discontinued after liver-safety findings.^[8] Here is what each trial showed and why none will reach pharmacies soon.

The short answer

• Small-molecule pills are the trend. Unlike oral semaglutide, these are non-peptide drugs, and at least one, safiglipron, is taken without fasting or food restrictions.^[5]
• Phase 2 weight loss so far is in the 7–11% range over 16–36 weeks at the higher doses.^[1][3][4][7]
• Side effects match the injectable GLP-1s: mainly nausea, vomiting, diarrhea and constipation, most common during dose escalation.^[4][7]
• Liver safety is the thing to watch. TERN-601's phase 2 study reported three cases of liver-enzyme elevations consistent with possible drug-induced liver injury, and its developer then stopped clinical development.^[8]

The candidates

Elecoglipron

Two phase 2 trials appeared in The Lancet in 2026. In VISTA, 310 adults with obesity or overweight (mean BMI 38.2) lost between 2.6% (5 mg) and 10.5% (75 mg with weekly titration steps) at 26 weeks, against 0.6% on placebo, and 40.4–88.8% reached at least 5% weight loss, against 15.6%. Adverse events were reported by 84–98% on elecoglipron and 84% on placebo, mostly nausea, constipation, diarrhea, headache and vomiting.^[1] In SOLSTICE, in type 2 diabetes, HbA1c fell between 0.91% and 1.88% at 26 weeks, against 0.15% on placebo.^[2]

Aleniglipron

The ACCESS phase 2b trial randomized 230 adults (mean BMI 39.5) to daily aleniglipron escalated every 4 weeks to 45, 90 or 120 mg. At 36 weeks, placebo-adjusted weight change was −8.2%, −9.8% and −11.3%, “with no apparent weight-loss plateau.” Treatment-related discontinuations were 10.4%, “with no events of drug-induced liver injury.”^[3]

HRS-7535, VCT220 and safiglipron (China)

HRS-7535 produced placebo-adjusted weight loss of 4.60% at 60 mg and 6.87% at 180 mg over 26 weeks; the 30 mg dose did not beat placebo.^[4] VCT220 reduced weight by 5.75% (80 mg) to 9.73% (160 mg) at 16 weeks, against 1.61% on placebo.^[7] Safiglipron, which “is administered without fasting or dietary restrictions,” has reached phase 3 in type 2 diabetes. It lowered HbA1c by up to 1.45 points against placebo and was non-inferior to dapagliflozin, though its weight loss was modest: up to 3.56% against placebo.^[5][6]

TERN-601: discontinued over liver safety

TERN-601 produced dose-dependent weight loss in phase 1 and significantly more weight loss than placebo at 12 weeks on doses of 500 mg or more in phase 2. But “three participants in the Phase 2 study experienced transaminase elevations consistent with potential drug-induced liver injury.” Those findings “led to clinical development discontinuation.”^[8] Liver safety is watched closely for this class; the aleniglipron trial, for example, reported explicitly that there were no drug-induced liver injury events.^[3]

Why small-molecule pills matter

• Easier to take. The Wegovy pill must be taken “on an empty stomach in the morning with water (up to 4 ounces),” followed by a 30-minute wait before eating or drinking.^[9] Some small molecules, including safiglipron, are taken without fasting or food restrictions.^[5] See how to take Foundayo for the approved example.
• No injections or cold storage. A tablet avoids pens and refrigeration.

When could they be available?

Not soon. Elecoglipron and aleniglipron have published phase 2 results but still need phase 3 trials before their developers can apply for FDA approval. HRS-7535, VCT220 and safiglipron have so far been tested only in China. None of these pills can be legally prescribed or compounded in the US. Products sold online under these names are not the real drugs. In the meantime, see the Foundayo approval and the Wegovy pill guide.

Bottom line

A new generation of daily GLP-1 pills is moving through trials, with phase 2 weight loss of about 7–11% over 16–36 weeks and the familiar GI side effects. The most advanced in obesity are elecoglipron and aleniglipron. Liver safety is the key open question for the class. For people who want a pill today, Foundayo and the Wegovy pill are the approved options.