Orforglipron (Foundayo) is now available in the UK following The Medicines and Healthcare products Regulatory Agency (MHRA) approval on 10 August, making the UK the first European country to license it for weight management and type 2 diabetes.
The first oral small-molecule GLP-1 agonist tablet differs from other oral GLP-1s as it has far fewer restrictions on how it can be taken. Compared to the oral Wegovy tablet, users can take it once daily, at any time, with no food or water restrictions.
It is available in six dose strengths, including 0.8 mg, 2.5 mg, 5.5 mg, 9 mg, 14.5 mg, and 17.2 mg, with the dose escalated stepwise at least every 30 days up to the maximum dose.
But what many don’t know is that it could be a good option for anyone coming off weight loss injections who wants to keep the weight off.
Maintenance is more critical than people think. GLP-1 treatments have historically had an exit problem, as appetite suppression stops when the medication stops, and follow-up data from the STEP 1 trial extension showed participants regaining two-thirds of their prior weight loss in the year after stopping semaglutide. People come off injectables for several reasons, such as the cost, needle fatigue, side effects, or even just reaching the weight they wanted. Until now, there has been no licensed step-down option to offer them, so a new daily tablet for maintenance is a genuinely new tool rather than another weight loss treatment in an already crowded market.
Why is it a good maintenance treatment?
The MHRA has explicitly licensed and indicated orforglipron as a weight maintenance medicine alongside weight loss.
In addition to a reduced-calorie diet and increased physical activity, Foundayo is an adjunct for weight management in adults with an initial BMI of 30 or more (obese), or with an initial BMI of 27 to 30 (overweight) with at least one weight-related comorbidity like prediabetes, type 2 diabetes, hypertension, dyslipidaemia, obstructive sleep apnoea, or cardiovascular disease.
The format is part of the appeal for maintenance specifically. Orforglipron needs no cold chain, no injection technique or sharps disposal, and it doesn’t have any food or water restrictions that people on other GLP-1s have to abide by. Adherence tends to slip once someone has hit their goal weight and the motivation of visible weekly progress disappears. A once-daily tablet is arguably better matched to a maintenance phase that may run for several years than a weekly injection is.
What the science says
A phase 3b ATTAIN-MAINTAIN study found orforglipron to be a sustainable solution for maintaining weight loss already achieved through other GLP-1s. It tested giving it to people who have already achieved significant weight loss on Mounjaro (tirzepatide) or Wegovy (semaglutide) injectables and reached a plateau, allowing them to continue treatment without continuing or stopping the injectable.
Anyone switching from tirzepatide on the maximum dose maintained all but 5kg of prior weight loss, while those on semaglutide maintained all but 0.9kg after 52 weeks on orforglipron, showing weight loss was largely retained rather than reversed.
A companion study of a lower dose of the Mounjaro injectable produced broadly similar maintenance results, although these were two separate trials rather than a head to head comparison. However, for people who prefer needle-free solutions, Foundayo may be the preferable choice.
It’s worth noting, however, that as the maintenance data runs to 52 weeks, we have not yet seen how it performs over a longer, multi-year period. It was also tested specifically on people who had already achieved weight loss and plateaued on an injectable, so it doesn’t tell us how someone who has never tolerated GLP-1 in the first place will fare. Equally, the 5kg differential seen in patients stepping down from maximum-dose tirzepatide is not nothing and is a conversation to have with a patient before switching rather than after.
People considering it should be aware of common gastrointestinal side effects, as well as rare warnings of things like acute pancreatitis, severe GI reactions, dehydration/acute kidney injury risk, hypotension, acute gallbladder disease, and (in diabetic patients) hypoglycaemia risk when combined with insulin/sulfonylureas.
It is not recommended for anyone with severe hepatic impairment or NYHA class IV heart failure and may reduce the efficacy of some contraception methods. It can also affect concomitant medicines, so patients should tell their prescriber what else they are taking.
What this means in practice
For anyone considering the switch, the sequencing is the part most people get wrong. Stepping down from an injectable is a clinical decision, not a swap.
Dose strength, how long the plateau has held and what tolerability looked like on the previous treatment all shape where escalation should start, and the licence requires at least 30 days at each step before moving up.
Patients should expect gastrointestinal effects to reappear at each escalation, even if they have settled on their previous treatment and should keep the same precautions they took on the injectable of hydration, protein intake, resistance exercise to protect lean muscle mass and a low threshold for reporting severe or persistent abdominal pain.
Maintenance also needs a review schedule attached to it. A tablet that is easy to keep taking is not a reason to stop reviewing whether it is still needed.
Looking forward
While it is available from private licensed providers, the new weight loss treatment is not yet NHS funded as NICE guidance is pending (expected mid-November). That decision is one to watch.
Being the first European market to license it puts UK prescribers ahead of the evidence-gathering curve on real-world maintenance use. And with further trials happening, it’s likely more patients will consider not just whether they should switch to an oral option like orforglipron, but which treatment offers the best value, and whether the NHS will play a big role in that.
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