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Long-term safety of oral orforglipron in Japanese participants with type 2 diabetes (ACHIEVE-J): a multicentre, randomised, open-label, parallel-group phase 3 trial
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Long-term safety of oral orforglipron in Japanese participants with type 2 diabetes (ACHIEVE-J): a multicentre, randomised, open-label, parallel-group phase 3 trial

The Lancet Diabetes & Endocrinology·August 17
Endocrinology & MetabolismConfirms priorType 2 DiabetesRandomized Controlled TrialGLP-1 Receptor AgonistAdultOrforglipron

Summary

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What was studied

This phase 3 trial evaluated the 52-week safety of once-daily oral orforglipron (3 mg, 12 mg, or 36 mg) as add-on therapy to diet/exercise alone or 1–2 oral antihyperglycaemic medications in 401 Japanese adults with type 2 diabetes.

Key findings

TEAEs occurred in 85% of participants overall, most mild-to-moderate; discontinuations due to adverse events were dose-dependent (3 mg: 5%, 12 mg: 8%, 36 mg: 14%), driven mainly by GI symptoms. No severe (level 3) hypoglycaemia occurred; level 2 hypoglycaemia was rare (2% each in the 12 mg and 36 mg groups).

Study limitations

Open-label design may introduce reporting bias; the study was limited to Japanese participants, restricting generalisability to other East Asian or global populations; no placebo or active comparator arm was included.

Clinical implications

Oral orforglipron appears to have an acceptable safety profile over 52 weeks in Japanese patients with type 2 diabetes, but GI-related discontinuations increase notably at the 36 mg dose — consider starting at lower doses and titrating carefully to balance tolerability.

Caveats

  • Efficacy endpoints (e.g., HbA1c change, weight loss) are not reported in this abstract; the primary endpoint was safety only.
  • No brand name for orforglipron was reported in the paper; it is an investigational oral GLP-1 receptor agonist developed by Eli Lilly.
  • Study population is exclusively Japanese; caution is warranted when extrapolating findings to other East Asian or non-Asian populations.
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  • This trial was open-label with no placebo or active comparator arm, which limits interpretation of safety findings relative to background therapy alone.

Related Questions

Explore related topics

What is the efficacy of orforglipron for HbA1c reduction in type 2 diabetes?How do GLP-1 receptor agonists compare in Japanese or East Asian patients with type 2 diabetes?What are the GI side effect rates and discontinuation patterns with oral GLP-1 receptor agonists?

Publication Details

Year
2026
Journal
The Lancet Diabetes & Endocrinology
Sample Size
n=401
Source
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