The expanding landscape of GLP-1 medicines

Glucagon-like peptide-1 medicines are being prescribed to growing numbers of patients worldwide, for type 2 diabetes, obesity and associated comorbidities, including cardiovascular disease, peripheral artery disease and obstructive sleep apnea, and are revolutionizing public health strategies for these conditions. These medicines improve health through reduction of blood glucose and body weight, by attenuation of inflammation and via direct activation of receptors in target tissues. New, more effective molecules with optimized pharmacokinetics produce greater weight loss and some may be more effective for various metabolic disorders, through incorporation of one or more additional peptide epitopes. Parallel efforts are exploring new indications, including neurodegenerative and substance use disorders, metabolic liver disease, arthritis, type 1 diabetes and inflammatory bowel disease. Here we highlight data informing the safety, efficacy, and potential utility of new and emerging glucagon-like peptide-1 medicines. We outline new mechanistic concepts, future therapeutic opportunities, potential for differentiation from currently available medicines and areas of uncertainty requiring additional investigation.