A clinical trial has been published tracking for one year whether weight loss persists after switching from the injectable weight-loss drugs Wegovy and Mounjaro to the pill form of Foundayo.

I read a clinical paper that followed patients who switched from an injection to a pill for one year. I also checked the patent published in 2026 by the Japanese company Nihon ChugaiChugai PharmaceuticalTSE 4519
Filings EDINET · Quote Yahoo!ファイナンス, which is the origin of this drug, as well as the current status of oral obesity drugs from Korean companies.

This is not an article evaluating the drug's efficacy or recommending its use. It is a direct translation of the numbers and their conditions as stated in the paper, and a count of the names listed in the patent and disclosure. All references can be verified through original source links.

Title

Orforglipron for maintenance of body weight reduction: the double-blind, randomized phase 3b ATTAIN-MAINTAIN trial

Publication venue

Nature MedicineNature Medicine
Journal · Website 32, 2679–2687 (2026) · Springer Nature

DOI

10.1038/s41591-026-04386-7

Clinical trial registration

NCT06584916

Date

Received 2026-02-12 · Accepted 2026-04-01 · Online release 2026-05-13

License

CC BY 4.0 · Free to read and reuse by anyone. Full text is available on Europe PMCEurope PMC
Data source · Website (PMC13375559)

Funding

Eli Lilly and Company. Specified in the paper

Verification date

2026-09-17

It is not a test to lose weight, but a test to maintain the lost weight.

What this paper measured was not the new weight loss effect, but how much of the already lost weight remained. Participants who had lost weight over one and a half years in the earlier SURMOUNT-5 trial were brought in, injections were stopped, and they were given either the oral orforglipron or a placebo that looked the same but had no effect. A placebo is used to eliminate the placebo effect and to assess the true effect of the drug. After another year, the percentage of the initially lost weight that remained was measured.

Participants were divided into two groups based on the injections they received in the previous clinical trial, which the paper refers to as cohort. The first group consisted of individuals who had received tirzepatide, the active ingredient in Mounjaro and Zepbound, while the second group included those who had received semaglutide, the active ingredient in Wegovy. In both groups, which were assigned more participants to the pill group, neither the patients nor the doctors knew who was receiving the real medication. This method, designed to prevent expectations or biases from influencing the results, is known as a double-blind trial. The pill started at a low dose and was increased by one level each month until reaching the maximum tolerable dose.

More than three-quarters of the weight lost remains if the medication is switched to a pill.

Retention rate refers to the proportion of weight lost in the previous clinical trial that remained lost one year later, measured only among individuals whose weight had stabilized. In both groups that switched to the pill, participants retained more than three-quarters of the weight they had lost, whereas those who switched to the placebo retained only about half or less. The difference between the pill and the placebo in the second group was larger and of a magnitude unlikely to be due to chance in both groups.

In other words, switching to the pill did not ensure that all the lost weight remained, as approximately one-quarter of the lost weight returned in the pill group over the year. The authors noted in their discussion that "for some patients, retaining most of the weight loss while experiencing a slight regain could be clinically acceptable." The conclusion of the paper leans toward this statement.

The most striking number is not the maintenance rate but the completion rate in the placebo group.

Among those who completed the year without any medication in the placebo group, only one out of three in the first group and one out of five in the second group managed to do so. The rest regained more than half of the lost weight and received the real medication according to the predetermined rules. This medication given during the trial is referred to as rescue medication. Additionally, some participants either started other commercially available weight-loss medications on their own or discontinued the trial, indicating that few individuals managed to go a year without medication.

This number allows the paper's claim to be read in two directions. It is a strength of the paper that most people cannot maintain without the drug, but it is also a weakness of the paper that the maintenance rate in the second placebo group comes from only 12 people. The authors also wrote in the discussion that the sample size is small, leading to large variations and potential distortion of the average.

Switching directly from injection to pill was fine for the stomach.

The second question in this trial was that the participants who received injections started directly at 12mg without gradually increasing the dose from a low level. During the first four weeks, about one in twenty participants experienced gastrointestinal side effects, but no one reduced the dosage. In the pill group, about one in twenty participants discontinued the drug due to unwanted symptoms, which are referred to as adverse reactions, and the most common side effects were nausea, vomiting, and diarrhea, all of which were mostly mild.

A separate point worth noting is liver values. In the first group pill group, four participants had ALT levels more than three times the upper limit of normal, while one participant each in the second group pill group and the placebo group experienced the same. A separate paper focusing solely on the liver safety of this drug was published in June 2026. One death was reported in the second group pill group due to cardiovascular or stroke-related causes.

Limitations stated by the authors, and limitations visible upon reading

• There is no comparison group receiving continuous injections. Since the only comparison is with a placebo, this paper cannot determine whether switching to pills or maintaining injections is better. The authors also listed this as the first limitation.
• The duration is one year. The results after two or three years are unknown.
• The trial was mainly conducted in U.S. hospitals with white participants. There is no evidence in this paper that the same results would be observed in Korean patients.
• Money and people are on one side. The research funding was provided by Eli Lilly, and eight out of the fourteen authors are employees and shareholders of Eli Lilly. The remaining six also disclosed in the conflict of interest section that they received consulting fees, research funding, or lecture fees from Eli Lilly. While there is no evidence of manipulation, one should be aware of who selected the numbers and wrote the sentences.
• The placebo group after 24 weeks is not a pure placebo group. Due to the structure of rescue medication rules, the comparison at the one-year mark is not between placebo and pill, but between a group that initially received placebo and later switched to pills, and the pill group. The paper described this as increasing interpretive complexity.

The original text is accessible to everyone.

This paper is under CC BY 4.0, so the original text can be read for free by anyone. You can access it by going to doi.org/10.1038/s41591-026-04386-7 or searching for PMC13375559 on Europe PMC. The numbers in this article are directly taken from the abstract, results, discussion, and extended table.

It is already being sold in the United States.

Lilly received approval in early April and began selling through its direct sales channels four days later. The tablets, available in six dosage strengths, are priced starting at $149 per month for patients without insurance. In its early August earnings report, the drug's revenue was first reported separately at $98,000,000. The same company's Mounjaro generated $9,900,000,000 in sales during that quarter, meaning this drug started at about one-hundredth of that scale. Lilly also announced that it had submitted an application to the FDA for an additional indication for diabetes during the same quarter.

It is under review in South Korea and the price is not yet available.

In South Korea, the monthly cost of Wegovy for those without health insurance ranges from about 210,000 won to 420,000 won, depending on the dosage. Industry reports predict a 2027 launch for Foundayo, which is currently undergoing drug approval review by the Ministry of Food and Drug Safety (MFDS). Lilly announced that it had submitted applications for approval in over 40 countries during the spring, and South Korea is included, though the South Korean sales price has not yet been disclosed. Unavailable figures are noted as such.

The company that earns revenue from this drug is two.

Then, when this drug is sold, to whom does the money go? The company that discovered opoglipron was not Lilly but Chugai Pharmaceutical, a Japanese company that transferred the drug to Lilly in 2018, as stated in the approval press release. Chugai Pharmaceutical announced in its mid-July earnings report that it began recording royalties—a percentage of sales as compensation for the invention—in its books starting from that quarter. The exact amount was not disclosed separately. The same report also noted that most new GLP-1 prescriptions in the U.S. were driven by patients using the drug for the first time and that the market for oral weight-loss drugs is growing.

Each time this drug is sold, the revenue goes to Lilly and the royalties go to Chugai Pharmaceutical, but South Korean companies are not part of this flow. We now look at where South Korean companies stand in this context.

Where are the companies trying to make the same drug? The following names are not selected by us. We selected 29 patents related to GLP-1 and obesity from over 50,000 English abstracts of patents published in the first quarter of 2026 by the Japanese Patent Office, and copied the applicants as they were. For South Korean companies, we copied the company announcements and news.

Chong Kun Dang revised the patent scope four months before the US approval.

Both applications were filed by Chong Kun Dang, and the inventors listed first are Yoshino, Tsukaya, Matsuo, and Sato. The abstract describes a compound combining an indole ring and a pyrazolopyridine skeleton, which can be administered orally and is described as a GLP-1 agonist with improved activity, metabolic stability, and bioavailability. Since the chemical name of Ozempic includes pyrazolopyridine and indole, it is considered to have the same skeleton.

What is notable is when the published patent application, typically disclosed 18 months after filing, was issued. However, in these two cases, the application was disclosed within a few months of filing, and this occurs when a divisional application split from the original application inherits the original application's disclosure date. Therefore, it appears that the original patent family from around 2017 was re-divided in the fall of 2025, just before the U.S. approval, and the scope of rights was revised. However, this sentence combines verified facts from the original text and inferences drawn from it, and the original application number is not provided in the English abstract, so it could not be confirmed.

Other oral GLP-1 patents filed in Japan in the same quarter

If the search is narrowed to low-molecular-weight GLP-1 agents that are small enough to be made into pills rather than large-molecule drugs like Wegovy that must be injected, only Japan and three locations in China remain, with none in South Korea. Among the 29 applications, the South Korean applicants are Hanmi Pharmaceutical and LG H&HLG H&HKOSPI 051900
Filings DART · Quote finance.naver.com. Neither has a molecular structure suitable for an oral obesity drug, so no South Korean company's oral GLP-1 molecule appears in the Japanese published patent application list for the first quarter of 2026. However, this does not mean they do not exist, but rather that they are not visible in this view, so any currently filed applications will not be published until after 2027.

Korean companies are at the stage before the start of phase 2 at the most advanced point

Reading the table in one line, in the year when the pill began to be sold in the U.S., the Korean company's oral obesity drug was still before the start of Phase 2, and the largest technology transfer case, where the rights to a drug in development were sold to another company, ended with one candidate being discontinued. The clinical data are all numbers announced by the company and not disclosed in academic papers, so this article does not verify those figures.

No one knows exactly when it will happen, but when and what will be disclosed is predetermined, so knowing the date alone changes the way one reads the news.

This article does not draw a conclusion but instead lists only three points to check in the future.

1. If the word "maintained" appears, check the denominator. The maintenance rate in this paper is based only on people with stable weight, only for one year, and only compared with placebo. There is no data yet comparing it with continued injections, so we will read it again when that paper is published.
2. The revenue from this drug is split into two parts. Eli Lilly's sales and Chugai Pharmaceutical's royalty. By reading the Foundayo line in the October results of both companies, you can see in numbers where the first quarter 98,000,000 dollars went.
3. Korean companies categorize by stages. Four words—preclinical, Phase 1 completed, Phase 2 partner undecided, and acquisition halted—summarize Korean companies as of September 2026. When the next news appears, just check which of these four words has changed.

What this paper does not answer is whether continuing injections or switching to a pill is better. The next thing to check is the October end financial results of the two companies and the MFDS approval list. In the next article, the same method will be applied to other drugs, connecting what the paper measured, what the company said, what the patent secured, and where the revenue actually secured, all in one line.