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Alternative Approaches Being Researched: Other Companies Oral GLP-1 Programs: Several pharmaceutical and biotech companies are developing oral GLP-1 or dual agonist medications: Pfizer: Developing oral GLP-1 receptor agonist (danuglipron) Different molecule than semaglutide or tirzepatide Phase 2 trials showed promise but also significant GI side effects Still years from potential approval Novo Nordisk: Researching higher-dose oral semaglutide formulations Exploring oral versions of other GLP-1 medications in pipeline Owns SNAC technology, giving them advantage Veru Inc.: Developing oral GLP-1 using different technology Early-stage research At least 5-7 years from approval if successful Structure Therapeutics: Oral GLP-1 receptor agonist in development Early clinical trials Results not yet published Realistic Expectations: Whats Likely by 2030: Improved oral semaglutide formulations (higher doses, better absorption) Possibly oral tirzepatide if development accelerates Other oral GLP-1 medications from competing companies Better absorption technologies Whats Unlikely by 2030: Oral GLP-1 medications as effective as current injections Oral medications without strict dosing requirements Oral options significantly cheaper than injections The Physics Problem: Even with better technology, oral peptides face fundamental limitations: Large molecules dont easily cross intestinal barriers Digestive system will always break down some medication First-pass liver metabolism reduces bioavailability Perfect oral bioavailability is likely impossible for peptides this size Most Likely Outcome: Future oral tirzepatide will probably: Require higher doses than injectable (like Rybelsus does now) Have strict administration requirements Be less effective than injectable versions Cost similar to or more than current brand-name injectable options Serve niche population unable or unwilling to inject Should You Wait for Oral Tirzepatide

In October 2024, Lilly announced a partnership with Health Innovation Manchester and The University of Manchester to initiate a five-year real-world study, SURMOUNT-REAL UK [9]

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