The Anti-Obesity Drug Pipeline: Peptide Hormones and Novel Targets Being Developed to Fight Obesity

This is a narrative review surveying the anti-obesity drug development pipeline as of 2018. The authors reviewed clinical trial data, preclinical studies, and mechanistic research on drugs at various stages of development, organized by their mechanism of action and molecular targets.

This review captures a pivotal moment in obesity pharmacology — many of the drugs discussed (particularly semaglutide) went on to transform the field. Understanding the breadth of peptide-based approaches in development provides context for the current obesity drug landscape and highlights next-generation therapies that may further improve on current options.

Written in 2018, this review proved remarkably prescient about the direction of obesity pharmacotherapy. Semaglutide, discussed here as a promising pipeline drug, became one of the most transformative medications in medicine. The dual and triple agonist approach (GLP-1 + GIP and/or glucagon) has also advanced significantly, with tirzepatide (a dual GLP-1/GIP agonist) achieving FDA approval. The review serves as a snapshot of the obesity drug revolution in its early stages.

As a 2018 review, several of the drugs discussed have since either succeeded (semaglutide) or failed (beloranib was halted due to safety concerns) in development. The review could not predict which candidates would ultimately reach market approval. Some approaches discussed (anti-obesity vaccines, some dual agonists) remain in early development or have been deprioritized. The review also doesn't address long-term safety data that has since emerged for some of these agents.