Moderate · human
This network meta-analysis (NMA) systematically synthesized evidence from 25 randomized controlled trials across 12 interventions to compare the weight-loss efficacy and safety of four advanced anti-obesity medications — tirzepatide, semaglutide, cagrilintide, and the combination CagriSema (cagrilintide + semaglutide) — in adults with overweight or obesity. Searches were conducted across PubMed, Scopus, and Cochrane Central. Using random-effects NMA models, the study found that tirzepatide 15 mg produced the greatest mean percent body weight reduction (−17.97%), closely followed by CagriSema (−17.84%) and semaglutide 7.2 mg (−14.66%). For achieving ≥20% body weight loss, CagriSema showed the highest relative risk (RR 27.82), followed by tirzepatide 15 mg (RR 23.70). All agents increased gastrointestinal adverse events (RR 1.33–1.91) relative to placebo, with the highest treatment discontinuation seen with semaglutide 7.2 mg (RR 3.09). Serious adverse events were comparable to placebo across all regimens. Key limitations include reliance on indirect comparisons due to absence of head-to-head trials, potential heterogeneity across trial populations and follow-up durations, and the emerging/limited trial data for CagriSema specifically. The authors conclude that both tirzepatide and CagriSema represent leading options for substantial weight loss but call for direct comparative trials.
Endocrinology, diabetes & metabolism · Jul 2026DOI ↗ 🧪 TrialInsufficient
Registered Phase 4 interventional trial (not yet recruiting). Prediabetes affects millions of adults worldwide and carries a high risk of progression to type 2 diabetes. Mazdutide is a once-weekly injectable drug that activates both GLP-1 and glucagon receptors, lowering blood sugar and body weight simultaneously. This study (DREAM-PRE) tests whether mazdutide can help adults with prediabetes return to normal blood sugar levels. Approximately 150 adults aged 18-75 years with prediabetes and BMI ≥22 kg/m² will be randomly assigned in equal numbers to one of three groups: mazdutide 4 mg once wee
ClinicalTrials.gov · Jun 2026View trial ↗ 🧪 TrialInsufficient
Registered Phase 3 interventional trial (not yet recruiting). This is randomized, double-blind, placebo-controlled study of the long-term efficacy, safety, and tolerability of multiple doses of aleniglipron in participants living with overweight or obesity and T2DM. Participants will be randomized to aleniglipron or placebo for a total of 76 weeks of treatment.
ClinicalTrials.gov · Jun 2026View trial ↗ 🧪 TrialInsufficient
Registered N/A interventional trial (recruiting). The purpose of this study is to examine the effects of resistance exercise, such as weightlifting, on retention of muscle mass and mental health in individuals taking GLP-1 RAs (an obesity medication). Resistance exercise is focused on increasing the strength of participants' muscles, such as how much participant can lift. •The duration of this study is 3 months. This includes: * Orientation session to explain study protocol, exercise program, and complete questionnaire about participants' medical history and lifestyle. * Two health assessments
ClinicalTrials.gov · Jun 2026View trial ↗ 🧪 TrialInsufficient
Registered Phase 3 interventional trial (not yet recruiting). Study GSBR-1290-12 is a Phase 3 pivotal, multicenter, global, randomized, placebo-controlled, double-blind study to investigate the long-term efficacy, safety, and tolerability of 3 maintenance doses of aleniglipron once daily (QD) compared with placebo, when used in combination with a reduced-calorie diet and increased physical activity. All participants will be randomized to at least 76 weeks of treatment to evaluate the effects on long term body weight changes, tolerability, and safety. In addition, the study will compare the eff
ClinicalTrials.gov · Jun 2026View trial ↗ 🧪 TrialInsufficient
Registered Phase 3 interventional trial (not yet recruiting). This study is a multicenter, randomized, open-label, parallel-group, semaglutide injection-controlled clinical trial. It aims to evaluate the non-inferiority of UBT251 Injection in glycemic control compared with Semaglutide Injection after 36 weeks of continuous administration in study participants with Type 2 Diabetes Mellitus (T2DM) and inadequate glycemic control on oral antidiabetic medications.A total of 956 participants are planned to be enrolled, including the UBT251 Injection 2 mg group, 4 mg group, 6 mg group, and Semagluti
ClinicalTrials.gov · Jun 2026View trial ↗ 🧪 TrialInsufficient
Registered observational trial (recruiting). Obesity is a chronic multifactorial disease with a strong genetic component. Although glucagon-like peptide-1 (GLP-1) receptor agonists such as semaglutide and dual glucose-dependent insulinotropic polypeptide (GIP)/GLP-1 receptor agonists, such as tirzepatide, are highly effective treatments for obesity, substantial inter-individual variability in weight loss response remains. Genetic factors may contribute to these differences in treatment outcomes. The aim of this prospective cohort study is to investigate whether a Genetic Risk Score (GRS) and s
ClinicalTrials.gov · Jun 2026View trial ↗ 🧪 TrialInsufficient
Registered N/A interventional trial (active not recruiting). The goal of this clinical trial is to learn whether a mindfulness-based nutrition group program is feasible and acceptable for adults with obesity who are taking GLP-1 receptor agonist medication and receiving usual medical care, including dietetic counselling. The main questions this study aims to answer are: Can this group program be successfully carried out with adults receiving GLP-1 treatment? Do participants find the program useful, acceptable, and manageable? Are participants willing to attend the sessions, complete the home e
ClinicalTrials.gov · Jun 2026View trial ↗ 🧪 TrialInsufficient
Registered observational trial (recruiting). This study will assess the impact of genetic markers, microbiological (microbiome) and behavioral factors on tolerance, adherence and effectiveness of dual GLP1/GIP RA in the treatment of obesity. 200 consecutive patients who meet all inclusion and none of the exclusion criteria will be enrolled.
ClinicalTrials.gov · Jun 2026View trial ↗ 🧪 TrialInsufficient
Registered Phase 1/Phase 2 interventional trial (recruiting). Alzheimer's disease (AD) is the most common cause of dementia. Despite major research efforts, effective treatments that slow or stop disease progression remain limited. Growing evidence suggests that inflammation in the brain and the body plays a key role in the onset and progression of AD. In particular, immune cells called regulatory T cells (Tregs), which normally help control inflammation, are impaired in AD individuals. This leads to increased activity of harmful immune pathways that worsen brain injury. Interleukin-2 (IL-2) i
ClinicalTrials.gov · Jun 2026View trial ↗ Review
This 2026 American College of Physicians (ACP) living clinical guideline synthesizes systematic reviews on pharmacologic treatments combined with lifestyle modifications for weight management in nonpregnant adults with overweight or obesity in outpatient settings, using the GRADE framework. For adults with obesity (BMI ≥30 kg/m²), the ACP issued conditional recommendations favoring semaglutide and tirzepatide as first-line agents (moderate-certainty evidence), phentermine-topiramate as second-line (low-certainty), liraglutide as third-line (low-certainty), and naltrexone-bupropion as fourth-line (low-certainty). For adults with overweight (BMI ≥27–30 kg/m²) who also have type 2 diabetes, dyslipidemia, hypertension, obstructive sleep apnea, or cardiovascular disease, the guideline conditionally recommends semaglutide and tirzepatide as first-line and liraglutide as second-line. All recommendations are conditional, reflecting the importance of shared decision-making around benefits, harms, costs, access, comorbidities, contraindications (e.g., cardiovascular contraindication and monthly pregnancy-test requirement for phentermine-topiramate; suicidal ideation risk with naltrexone-bupropion), and patient preferences. The living guideline format signals ongoing updates as new evidence emerges.
Annals of internal medicine · Jun 2026DOI ↗ Strong · human
This living systematic review and network meta-analysis, commissioned by the American College of Physicians, synthesized evidence from 69 randomized controlled trials involving 112,511 adults with overweight or obesity (BMI ≥25 kg/m²) to compare pharmacologic weight-management treatments. Drugs examined included GLP-1 receptor agonists (semaglutide, liraglutide, dulaglutide, exenatide, lixisenatide), dual agonists (tirzepatide, retatrutide, semaglutide-cagrilintide), and other agents (naltrexone-bupropion, phentermine, phentermine-topiramate, orforglipron), with or without lifestyle intervention. The review found that nearly all studied interventions produced greater weight loss than placebo and/or lifestyle intervention alone. Semaglutide was found to probably reduce mortality and major adverse cardiovascular events (MACE). Semaglutide and tirzepatide demonstrated the greatest weight loss in both pairwise and network meta-analyses. However, nearly all active treatments were also associated with more treatment discontinuations due to adverse events compared with placebo. The authors noted that evidence for critical outcomes such as mortality, MACE, and serious adverse events remained limited, and direct head-to-head comparisons between treatments were scarce. Thirty-seven of the 69 included studies were rated at low risk of bias. The living review design allows for ongoing evidence updates as new trials emerge.
Annals of internal medicine · Jun 2026DOI ↗ Review
This systematic review, conducted for the American College of Physicians, evaluated the cost-effectiveness of pharmacologic treatments for overweight or obesity in U.S. adults. Researchers searched MEDLINE, Embase, and economic databases through October 2025, ultimately including 9 studies encompassing 42 pairwise treatment comparisons. Study quality was assessed using the CHEQUE tool, value was measured via incremental cost-effectiveness ratios (ICERs) against established willingness-to-pay thresholds, and certainty of evidence was graded using GRADE. Key findings from the 6 moderate-certainty studies suggested that liraglutide had low value compared with lifestyle modification, while phentermine-topiramate and tirzepatide showed high value versus lifestyle modification. Semaglutide demonstrated low value compared with naltrexone-bupropion and phentermine-topiramate, but high value compared with liraglutide. Important limitations include that all 9 included studies were model-based rather than empirical trial-based analyses, only 4 of 9 were at low risk of bias, none of the 42 comparisons reached high certainty, and reporting was frequently incomplete. The authors conclude that current U.S. evidence on cost-effectiveness of obesity pharmacotherapy is significantly hampered by poor study quality, restricting the strength of any conclusions that can be drawn.
Annals of internal medicine · Jun 2026DOI ↗ Limited · human
This retrospective, real-world study used the TriNetX federated database to compare oncologic outcomes in postmenopausal women aged ≥50 with obesity (BMI ≥30) and stage 0–III breast cancer, across three groups: GLP-1 receptor agonist (GLP-1RA) users, bariatric surgery patients, and those receiving both interventions. Two propensity score–matched analyses (1:1) adjusted for age, BMI, tumor stage, receptor status, adjuvant therapy, and comorbidities. Study 1 (n=3,438 matched per group) found that GLP-1RA users had a lower instantaneous mortality risk (HR 0.57, 95% CI 0.45–0.73) and lower locoregional recurrence (LRR) rate (1.8% vs. 4.7%; HR 0.52) compared to bariatric surgery alone, despite similar 10-year overall survival (87% vs. 83%). Study 2 (n=1,129 matched per group) found that combined bariatric surgery plus GLP-1RA therapy was associated with higher 10-year overall survival (91% vs. 80%; HR 0.44) and lower LRR (2.5% vs. 5.8%; HR 0.52) versus surgery alone. The authors hypothesize potential anti-inflammatory, insulin-modulating, or other metabolic mechanisms beyond weight loss. Key limitations include the observational design, potential residual confounding, lack of GLP-1RA dose/duration data, and inability to establish causality.
Annals of surgery · Jun 2026DOI ↗ Review
This review examines the evolving medical management of short bowel syndrome intestinal failure (SBS-IF), a condition historically associated with lifelong dependence on home parenteral support (HPS) and, in select cases, intestinal transplantation (iTx). The authors describe how recent pharmacological advances—particularly glucagon-like peptide-2 (GLP-2) analogues and GLP-1 receptor agonists—have been integrated alongside conventional antimotility and antisecretory therapies to promote intestinal adaptation. The review argues that SBS-IF should now be understood as a dynamic and potentially modifiable form of organ failure rather than a static, irreversible condition. According to the authors, GLP-2 analogues represent the first pathophysiology-targeted, pro-adaptive therapies in this disease, while GLP-1 receptor agonists are highlighted as promising adjuncts, especially for patients with high-output phenotypes. The paper contends that multidisciplinary intestinal rehabilitation and gut-directed pharmacotherapy have meaningfully altered the natural history of SBS-IF, reducing HPS dependence and improving patient-centered outcomes. A key implication discussed is that iTx has been repositioned from a default end-stage intervention to a targeted rescue option used after optimized rehabilitation. Limitations include the review format, which synthesizes existing literature without presenting new primary data or meta-analytic pooling.
Current opinion in organ transplantation · Jun 2026DOI ↗ Preclinical
This study investigated why chemotherapy often fails to generate robust anti-tumor immunity and how the endogenous peptide thymosin alpha-1 (Tα-1) might address this gap. The researchers first observed that circulating levels of Tα-1 were reduced after chemotherapy in both cancer patients (across multiple tumor types) and tumor-bearing mice. Mechanistically, the study found that chemotherapy-induced cancer cell death produces apoptotic bodies (ABs) that are poorly immunogenic. Tα-1 was shown to bind to these ABs and interact specifically with AB-associated microRNAs—particularly miR146a-5p—protecting them from degradation by lysosomal RNase A inside dendritic cells (DCs). This protection allowed miR146a-5p to activate Toll-like receptor 7 (TLR7), which in turn licensed DC maturation, migration to tumor-draining lymph nodes, and presentation of tumor antigens to CD8+ T cells. In mouse models, therapeutic Tα-1 supplementation synergized with chemotherapy to suppress established tumors in a TLR7-dependent and miR146a-5p-dependent manner. Limitations include that mechanistic and therapeutic efficacy data are primarily from mouse models, with human data limited to observational measurements of circulating Tα-1 levels.
Cancer research · Jun 2026DOI ↗ InsufficientPreprint
This bibliometric study compared the 100 most-cited articles on GLP-1 receptor agonists (GLP-1RA) with the 100 most-cited articles on metabolic bariatric surgery (MBS), using the Bibliometrix software to analyze citation patterns, journal distribution, and journal impact factors (IF). The study found that GLP-1RA articles accumulated more total citations (91,660 vs. 72,243) and had a higher median citation count (718 vs. 551) than MBS articles. GLP-1RA research was also more internationally collaborative (57% vs. 26%) and appeared more frequently in journals with IF above 40 (41% vs. 25%). The weighted 5-year mean IF was substantially higher for GLP-1RA journals (35.4 vs. 21.6). The authors argue that these differences may reflect a "prestige-journal effect," whereby GLP-1RA trials' placement in flagship journals such as the NEJM and Lancet inflates citation counts relative to MBS research, which is more dispersed across surgical specialty journals. A key limitation is that this study analyzes publication patterns rather than clinical outcomes, and cannot establish whether citation differences reflect true differences in scientific merit. The authors conclude that journal-impact inequalities should be considered when making citation-based comparisons between therapeutic fields.
Unknown journal · Jun 2026DOI ↗ In vitro
This study presents a novel chemical platform for installing carbon-14 (¹⁴C) or tritium (³H) radiolabeled lysine residues directly onto solid-supported peptides, circumventing the high cost and complexity of traditional radiolabeling methods. The researchers developed a two-step workflow: first, a mild hydroformylation reaction converts allylglycine residues — already incorporated into the peptide on a solid support — into a labeled allysine intermediate using either ¹⁴CO (generated from solid precursors) or ³H₂ gas. Second, reductive amination converts allysine into a radiolabeled lysine residue, with the final labeled peptide released upon cleavage from the solid support. The study reports that the optimized conditions are compatible with diverse peptide sequences and were successfully applied to analogs of semaglutide, a complex pharmaceutical peptide. The platform's key advantages highlighted by the authors include late-stage isotope introduction, flexibility in choosing the radiolabel, and avoidance of lengthy multi-step synthesis. Limitations include that this is a synthetic chemistry methods paper with no biological or clinical testing; all work was conducted in vitro at the bench-chemistry level. No pharmacological, pharmacokinetic, or efficacy data in animals or humans are reported.
Nature communications · Jun 2026DOI ↗ Animal only
This systematic review (PRISMA-guided) examined whether GLP-1 receptor agonists (GLP-1 RAs) exert neuroprotective effects in preclinical models of stroke and Parkinson's disease (PD). Researchers searched four major databases (Cochrane CENTRAL, PubMed, Web of Science, Scopus), identifying 1,643 records and ultimately including 13 experimental animal studies published between 2013 and 2026. For stroke, studies primarily used middle cerebral artery occlusion (MCAO) models; the review found that agents such as liraglutide and linagliptin were associated with notable reductions in infarct volume and improved neurological deficit scores in treated animals. For PD models, the included studies reported improvements in motor function, preservation of dopaminergic neurons, and reduced α-synuclein aggregation. Across both disease models, GLP-1 RAs appeared to modulate neuroinflammatory markers (TNF-α, IL-1β, IL-6), oxidative stress indicators (ROS, 4-HNE), and apoptotic pathways (increased Bcl-2, decreased Bax). Risk of bias assessment using the SYRCLE tool rated overall quality as moderate, with four studies flagged as high risk due to small sample sizes and inadequate reporting of randomization and blinding procedures. The authors concluded that while preclinical evidence appears promising, standardized studies and clinical trials are needed before translational conclusions can be drawn.
Disease-a-month : DM · Jun 2026DOI ↗ Animal only
This study developed a targeted nanodelivery system — GLP-1@tMSN (glucagon-like peptide-1 loaded into matrix metalloproteinase-2-targeted mesoporous silica nanoparticles) — designed to mobilize endothelial progenitor cells (EPCs) and promote re-endothelialization following coil embolization of intracranial aneurysms (IAs). Using a rat coiled aneurysm model, the researchers evaluated whether the platform could recruit EPCs to the lesion site and accelerate vascular repair. The study found that GLP-1@tMSN significantly enhanced EPC recruitment and re-endothelialization compared to controls. After 28 days, histological analysis showed formation of mature endothelial-like tissue in treated animals, while controls exhibited fibrous tissue. Immunofluorescence confirmed preferential accumulation of CD34+VEGFR2+ EPCs at the lesion site, alongside activation of the Wnt/β-catenin signaling pathway, which the authors implicate as a key driver of vascular repair. Preliminary biocompatibility assessments suggested an acceptable safety profile. Limitations include the exclusive use of a rat model, a single 28-day follow-up endpoint, small experimental scale, and lack of human translational data. The authors conclude that this nanotherapeutic approach may hold promise for reducing long-term IA recurrence after embolization, though clinical validation is needed.
Journal of neurosurgery · Jun 2026DOI ↗