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Persistence The most underestimated commercial factor The biggest gap between trial and reality Hype vs Reality Lets cut through it: Overhyped Oral GLP-1s will fix adherence Not proven Tirzepatide already owns CV outcomes Not in obesity OSA means CPAP is dead Not even close More weight loss always wins increasingly false Underappreciated Semaglutides moat is now multi-indication OSA is commercially bigger than it looks Oral is splitting into two very different categories Persistence is the real bottleneck Access strategy may matter more than efficacy What Happens Next (20262027) Beyond Novo and Lilly, the next wave is forming: CagriSema still relevant, but no longer dominant narrative Zenagamtide (amycretin) next-gen potential Orforglipron convenience-led disruption MariTide durability + less frequent dosing CT-388 / petrelintide / VK2735 / survodutide differentiated bets The shift here is important: The next wave isnt just more GLP-1 Its different mechanisms, tolerability and persistence strategies The Bigger Shift Most People Miss This market is moving beyond endocrinology
Nutrients 12 (9), 2499
doi: 10.1016/0002-9378(95)90336-4 63 KandzijaNZhangWMotta-MejiaCMhlomiVMcGowan-DowneyJJamesTet al
Larger randomized controlled trials are still ongoing
