AstraZeneca is pushing its small molecule GLP-1 drug to Phase 3 development for weight control, diabetes and other cardiometabolic conditions despite the asset failing to best one from Structure Therapeutics.
AstraZeneca’s GLP-1 pill significantly and meaningfully reduced weight and blood sugar levels in a pair of mid-stage studies—but not enough to sufficiently outperform a key competitor from Structure Therapeutics.
The pharma’s asset, dubbed elecoglipron, showed “promising efficacy” in the Phase 2b VISTA study in patients with overweight or obesity, BMO Capital Markets wrote in a Monday evening note. Indeed, AstraZeneca’s data at the 2026 annual conference of the American Diabetes Association showed a 10.5% average decrease in body weight at 25 weeks, as compared with 0.6% in placebo counterparts.
Elecoglipron also did not show plateauing during the study, with weight reduction increasing further to 11.8% at 36 weeks, while placebo was 0.3%.
Still, BMO called these findings “relatively underwhelming,” especially when compared against Structure’s aleniglipron, which was also on display at ADA with 15.3% placebo-adjusted weight loss at 36 weeks when 120 mg dosing was escalated to 240 mg. A 120-mg dose of aleniglipron resulted in an 11.3% reduction in weight at the same time point.
Elecoglipron and aleniglipron are both orally available small-molecule agonists of GLP-1. There hasn’t yet been a direct head-to-head study comparing the two drugs, and cross-trial comparisons are inconclusive.
AstraZeneca might have a slight edge in terms of safety, according to BMO, but the difference may not be enough to set back Structure. “While rates of nausea and [adverse events] leading to treatment discontinuation are slightly lower, we do not see this difference as particularly meaningful,” the analysts wrote.
Also at ADA, AstraZeneca presented data from the Phase 2b SOLSTICE study, testing elecoglipron in patients with type 2 diabetes. HbA1c, an indicator of blood sugar levels over the past two to three months, dropped 1.9% at 26 weeks versus baseline, versus 0.2% in placebo comparators.
BMO handed AstraZeneca the victory on this front, writing on Monday that elecoglipron’s HbA1c findings “appear slightly improved” versus Eli Lilly’s orforglipron, a similar drug recently approved as Foundayo for obesity. Still, this mild edge “is unlikely to be a material drag” on Lilly’s shares, given the Indiana pharma’s head start, the analysts added.
