The Unmet Needs That Will Define the Next Generation of GLP 1s: Q&A with Dr. Bo Liang

The GLP-1 landscape is a fast-evolving sector of the industry. The medications became popular only a few years ago when they were approved for weight-loss treatments. Since then, sales of the drugs have sky rocketed.

Along with rising sales, GLP-1s are a major focus for R&D teams. Major pharma companies are developing new versions of the medication that are easier for patients to use, while also funding research into areas outside of weight-loss where they may also be effective.

Pharmaceutical Executive spoke with Dr. Bo Liang, chief medical officer at CORXEL, about the trajectory of GLP-1s. Dr. Liang previously worked at Novo Nordisk, where he lead global clinical development and regulatory submission for semaglutide. During the conversation, he spoke about recent developments with the medications and where he sees the sector moving in the coming years.

Click here for the video version of this interview.

Pharmaceutical Executive: What is the next chapter in metabolic drug development?
Dr. Bo Liang: When we look at obesity and where the next generation of treatments should go, the fundamental question is: where are the unmet medical needs? If we examine the treatments currently available, efficacy is no longer the most significant gap. The four areas of greatest unmet need are as follows.

First, reducing GI adverse events. Minimizing or mitigating gastrointestinal side effects is the top priority for the next generation of obesity therapies.

Second, convenience and adherence. Whether we are talking about injectable or oral peptide therapies, every current option has limitations in terms of how easy it is for patients to stay on treatment long-term.

Third, lean mass preservation. When patients achieve body weight reduction on current therapies, they also lose a significant amount of muscle mass alongside fat. Addressing that is an important direction for next-generation development.

Fourth, weight regain after treatment discontinuation. Once patients stop treatment, body weight typically returns. Developing medications that produce more durable outcomes — or that can support patients through transitions off therapy — is another key priority.

These four directions define where the next generation of obesity treatments needs to go.

Pharmaceutical Executive: How will a shift towards oral medications impact the GLP-1 space?
Dr. Bo Liang: The shift toward oral treatments will continue to accelerate, primarily because oral delivery addresses what I identified as the second largest unmet need in obesity — convenience and adherence. The obesity market is increasingly behaving like a consumer market, and most patients in that market are not accustomed to injectables. They prefer oral options, and I believe small molecule oral therapies will be the long-term winners in this space.

If you look at the two oral products already on the market, the commercial uptake has been quite remarkable — and that momentum is a clear signal of where patient preference is heading.

Pharmaceutical Executive: Over the last decade, what was the most surprising development in GLP-1s?
Dr. Bo Liang: Based on my experience — I spent eleven years at Novo Nordisk from 2013 — I can trace how this field has evolved. When Saxenda was first developed as an obesity treatment, efficacy was still the most significant unmet medical need. Saxenda successfully addressed many of the safety concerns associated with earlier anti-obesity medications, which was an important step forward.

But the biggest achievement since then — and I would call it genuinely surprising in terms of how far the field has come — is that current medications are now able to deliver more than 10 to 15% body weight reduction. Some compounds are now achieving efficacy comparable to bariatric surgery. That is the single most significant advancement we have seen over the last ten to fifteen years in obesity medicine.

Pharmaceutical Executive: Beyond weight loss, where is GLP-1 development headed?
Dr. Bo Liang: If you look at the full range of clinical benefits the GLP-1 class has demonstrated, obesity is only one part of the story. The GLP-1 class has clearly shown clinical benefit across cardiovascular outcomes, renal outcomes, and a broad range of obesity-related comorbidities and chronic complications — including sleep apnea and metabolic-associated steatohepatitis.

We believe GLP-1 therapies are not obesity treatments in the narrow sense. They represent a broader therapeutic platform for multiple chronic diseases, one that can deliver long-term clinical benefit for patients living with obesity and its many associated complications.