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Technology trajectory: The field is converging on three next-generation directions: (1) oral small molecule GLP-1RAs (Lilly, Pfizer, Roche, Viking all in Phase 3), (2) multi-receptor co-agonists with superior efficacy (retatrutide, survodutide, GLP-1/FGF21 combos), and (3) biased agonism for improved tolerability (Sciwinds ecnoglutide as proof of concept)

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