The single-target miracle, this is the era of GLP-1.
On August 5, Eli Lilly released its 2026 first-half performance report. One number took the entire pharmaceutical industry’s breath away: Tirzepatide — the glycemia-lowering version Mounjaro and the weight-loss version Zepbound — posted combined revenue of 27.693 billion US dollars in the first half of the year, representing an 88% year-on-year increase
A single product generating 27.7 billion US dollars in half a year is a figure that the vast majority of pharmaceutical companies worldwide cannot reach in a full year, yet Tirzepatide achieved it in only six months. Its direct rival, Novo Nordisk’s Semaglutide, recorded a result of about 17.5 billion US dollars in the same period. The two drugs totaled approximately 45.2 billion US dollars in half a year. The two GLP-1 target-based drugs lead all other drugs in the world by a huge margin
Extending the timeline to the full year, Tirzepatide’s full-year revenue is expected to rise to more than 55 to 60 billion US dollars, and the full series of Semaglutide products are projected to reach close to 35 to 40 billion US dollars. Combined, their total 2026 full-year sales will very likely hit 100 billion US dollars
One target, two drugs, generating 100 billion US dollars in annual revenue. This is a number that has never appeared in the history of human pharmaceuticals
01 From 45.2 Billion in Half a Year to 100 Billion in the Full Year
Breaking down the figures for the first half of 2026: Tirzepatide reached 27.7 billion US dollars, of which the glycemia-lowering version Mounjaro accounted for about 16.6 billion US dollars and the weight-loss version Zepbound about 11.1 billion US dollars; Semaglutide totaled about 17.5 billion US dollars, including the glycemia-lowering injection Ozempic of about 9.6 billion US dollars, the weight-loss injection Wegovy of about 7.2 billion US dollars, and the oral glycemia-lowering tablet Rybelsus of about 700 million US dollars. The two drugs jointly contributed 45.2 billion US dollars.
Dataarnings Report. Mounjaro and Zepbound are the glycemia-lowering and weight-loss formulations of Tirzepatide respectively, while Ozempic, Rybelsus and Wegovy are the glycemia-lowering injection, oral glycemia-lowering tablet and weight-loss version (including injection and oral tablet) of Semaglutide respectively
Based on its better-than-expected performance in the second quarter, Eli Lilly has raised its 2026 full-year revenue guidance from 80 to 83 billion US dollars at the beginning of the year to 85 to 87 billion US dollars, of which Tirzepatide is the absolute main force, and institutions predict that its full-year sales are expected to exceed 55 to 60 billion US dollars
Although Ozempic and Rybelsus have shown weak momentum, down 2% and 9% year-on-year respectively, the new oral formulation of Semaglutide Wegovy is in the early stage of explosive growth — since its launch in early 2026, the number of prescriptions has exceeded 5 million, and its first-half sales reached 855 million US dollars. Coupled with the 7% growth of the Wegovy injection version, Semaglutide’s sales are expected to stabilize or even rise in the second half of the year. Novo Nordisk has raised its full-year guidance, optimistically predicting that the total annual Semaglutide revenue will remain in the range of 35 to 40 billion US dollars.
The combined total sales of Tirzepatide and Semaglutide in 2026 will most likely reach or even exceed 100 billion US dollars
What is more noteworthy is the directional change in the gap between the two. In the full year of 2025, the revenue gap between Tirzepatide and Semaglutide was less than 2 billion US dollars; while in the first half of 2026, this gap has expanded to 10.2 billion US dollars. Eli Lilly’s Tirzepatide is redrawing the power landscape of the GLP-1 era with the advantage of dual targets
02 One Target, the Master Switch of Whole-Body Metabolism
GLP-1 is originally an incretin secreted by intestinal L cells, which stimulates insulin secretion and inhibits glucagon secretion after eating. But scientists have gradually discovered that it has far more functions than just lowering blood sugar. GLP-1 receptors are widely distributed in the brain’s appetite regulation area, myocardium, proximal renal tubules, vascular endothelium, liver and adipose tissue. Activating it is equivalent to pressing the master switch for whole-body metabolic remodeling.
At the central level, GLP-1 receptor agonists act on the hypothalamic appetite regulation center, enhancing satiety, reducing hunger signals, and delaying gastric emptying at the same time, making “eating less” less painful. As a dual agonist of GIP and GLP-1, Tirzepatide activates two receptors simultaneously in the brain’s key appetite regulation areas, further strengthening the weight loss effect: the 15mg dose of Tirzepatide can achieve an average weight loss of 20 to 22 kg, while the 2.4mg dose of Semaglutide can achieve about 15 to 18 kg of weight loss.
At the cardiovascular level, GLP-1 can improve myocardial remodeling, resist atherosclerosis, and inhibit platelet activation and inflammatory responses by activating the nitric oxide synthase signaling pathway. The SELECT trial confirmed that Semaglutide reduced the risk of major adverse cardiovascular events by 20%, making it the world’s first and currently the only approved drug for long-term weight management that reduces the risk of cardiovascular events
At the renal level, GLP-1 receptor agonists inhibit the sodium-hydrogen exchanger 3 in the proximal tubule, induce natriuresis and diuresis, and reduce excessive activation of the renal RAAS system; at the same time, they inhibit the expression of inflammatory factors through the cAMP-PKA pathway, reducing renal tubulointerstitial fibrosis. The FLOW trial showed that Semaglutide significantly reduced the risk of major adverse renal events by 24% in patients with type 2 diabetes and chronic kidney disease.
At the liver and metabolic level, in August 2025, the FDA approved Wegovy for patients with MASH accompanied by moderate to severe liver fibrosis, which is the first time a GLP-1 receptor agonist has been approved for liver diseases
This is the systematic miracle of GLP-1: it is not only a hypoglycemic drug and a weight-loss drug, but also simultaneously improves glucose metabolism, lipid metabolism, renal perfusion, myocardial function, liver inflammation and the appetite center through continuous activation of one target, treating metabolic syndrome as a whole
This multi-benefit feature determines that its indication landscape will inevitably expand from diabetes and obesity to the full spectrum of indications including heart failure, chronic kidney disease, MASH, obstructive sleep apnea, Alzheimer’s disease and other diseases
03 Indication Landscape: From “Glycemia Lowering and Weight Loss” to “Whole-Body Metabolic Remapping”
1. Tirzepatide (Eli Lilly): Horizontal Expansion of Dual Targets
Approved indications (China NMPA): Glycemia control in adults with type 2 diabetes (May 2024), long-term weight management for adults with obesity or overweight (July 2024), moderate to severe obstructive sleep apnea (OSA) in adult obese patients, and combined insulin therapy to improve glycemia control in adults with type 2 diabetes
The results of the key Phase IIIb clinical trial SURMOUNT-MAINTAIN, which focuses on long-term weight maintenance after successful weight loss with Tirzepatide (5mg low-dose maintenance administration), were published in Lancet in May 2026. The data of the Phase III clinical trial SURMOUNT-HFpEF for heart failure with preserved ejection fraction HFpEF (obese population) have been read out, and Eli Lilly has submitted the relevant data to the FDA and NMPA. The status of Phase III clinical trials for other partial indications is shown in the table below.
2. Semaglutide (Novo Nordisk): In-Depth Indications + Oral Formulations
Approved indications (global): Type 2 diabetes (Ozempic injection, Rybelsus oral tablet), long-term weight management + MACE risk reduction (Wegovy injection), chronic kidney disease (CKD) approved by the FDA in January 2025, MASH with moderate to severe liver fibrosis (approved by the FDA in August 2025)
Formulation innovation: Wegovy oral tablet: approved in the US in December 2025, the world’s first oral GLP-1 drug for obesity treatment, with sales of 5.474 billion Danish kroner (about 855 million US dollars) in the first half of 2026; Wegovy HD (7.2mg high dose) was successfully launched in the US in 2026; CagriSema (Semaglutide + long-acting amylin analog): the marketing application has been submitted, trying to turn the tide with a compound preparation
Putting the two “maps” of indications together reveals a fact: the battlefield of GLP-1 drugs has been upgraded from “who has better weight loss effect” to “who can occupy more organs, more formulations and more populations”
04 Duopoly Pattern: How It Forms and Why It Persists
GLP-1 drugs cannot be developed by any enterprise that wants to
In terms of molecular engineering, Tirzepatide is a modified 39-amino acid polypeptide. The C20 aliphatic diacid group modification can bind to albumin and extend the half-life — this engineering capability of combining polypeptide with fatty acid modification is mastered by only a few enterprises worldwide
In terms of production capacity, Eli Lilly promised in the second quarter of 2026 to invest an additional 4.5 billion US dollars to expand its manufacturing base in Indiana, and Novo Nordisk also invested tens of billions of Danish kroner to expand production; freeze-dried injections, pen drug delivery devices, and cold chain distribution have extremely high heavy asset thresholds
In terms of clinical data, large-scale Phase III trials such as SELECT, FLOW, and SURMOUNT-OSA cost hundreds of millions of dollars and lasted for several years, which latecomers cannot make up for in a short time
In terms of patents, the core substance patents of Tirzepatide and Semaglutide will not expire in the United States and Europe until the 2030s respectively, so generic drugs cannot legally enter the market in the short term, but the core substance patents in China have expired in March 2026
Eli Lilly’s moat lies in its dual target: as the first dual agonist of GIP and GLP-1, Tirzepatide has a structural advantage over Semaglutide in weight loss amplitude — 20 to 22 kg versus 15 to 18 kg. This difference in efficacy means that the balance of clinical selection tilts towards Tirzepatide among obese patients, which is the fundamental clinical reason why Tirzepatide can widen the gap by 10.2 billion US dollars in the first half of 2026
Novo Nordisk’s defensive strategy focuses on formulations and in-depth indications: the world’s first oral GLP-1 weight-loss drug seizes the population that is afraid of injections; the three new indications of chronic kidney disease, MASH and cardiovascular disease have been approved, repositioning Semaglutide from a weight-loss injection to a drug for metabolic system diseases; the layout of CagriSema compound preparation plus amylin single drug prepares for the post-patent era
The medical insurance drive in the Chinese market is also a key variable. In 2026, Tirzepatide was included in China’s National Reimbursement Drug List for type 2 diabetes. Eli Lilly’s China region revenue reached 1.635 billion US dollars in the first half of the year, a 73% year-on-year increase, and the single-region revenue in the second quarter doubled year-on-year. The explosive demand brought by medical insurance’s strategy of exchanging price for volume has become a new engine for Eli Lilly’s global growth.
But the other side of the coin is that domestic GLP-1 drugs from Chinese enterprises including Huadong Medicine, United Laboratories, and Hui Sheng Biological have already launched price wars in the domestic market. Novo Nordisk’s overall Semaglutide sales in China in the first quarter of 2026 fell by 22.5% year-on-year, which was caused by the original research drug’s active price reduction to defend against the shock of generic drugs in advance
The biggest variable of the duopoly pattern is: Semaglutide recorded its first half-year sales decline since its launch in the first half of 2026. Does this mean that the competitive ceiling of single-target GLP-1 has appeared? After Eli Lilly’s retatrutide triple-target drug is launched in 2027, will active product iteration subvert itself? After oral small molecule GLP-1 — such as Eli Lilly’s Orforglipron — is approved, will the dominance of injections be weakened?
05 Conclusion: The Era of Single Target Generating 100 Billion US Dollars in Revenue
In 2026, Tirzepatide and Semaglutide jointly hit 100 billion US dollars in revenue, marking that the global pharmaceutical industry has entered an era where a single target can generate 100 billion US dollars in revenue. The duopoly confrontation between Eli Lilly and Novo Nordisk is not only competition, but also a symbiotic relationship of jointly educating the market, expanding indications together, and resisting generic drugs together
But historical experience repeatedly reminds us that no target can rule forever
Just as the market size of statins fell back from tens of billions of dollars, EGFR inhibitors were diverted by new generation TKIs, and the growth of PD-1 slowed down under the impact of bispecific antibodies and ADCs, the 100-billion-dollar glory of Tirzepatide and Semaglutide will eventually face internal subversion from retatrutide triple-target drugs, amylin single drugs, and oral small molecule GLP-1s, as well as external challenges from new generation metabolic targets
But at least in 2026, GLP-1 is the absolute center of the global pharmaceutical industry. Two drugs, two companies, and one target jointly create 100 billion US dollars in revenue, which is the best gift biology has given to the industry, and also the most extreme footnote to the miracle of a single target
When people in the future look back at the global pharmaceutical industry of this era, they may record it like this: this is an era where one target defines a company and one molecule reshapes an industry, this is the era of GLP-1
This article is from the WeChat official account
