Eli Lilly's GLP-1 pill Foundayo alleviated sleep apnea in two late-stage studies, according to STAT News, though it does not appear as effective as the company's injectable drug Zepbound. The data were presented Monday at the annual meeting of the American Heart Association and published in JAMA.

Obstructive sleep apnea is measured on the apnea-hypopnea index, or AHI, which counts how many times per hour a person's breathing stops or becomes restricted during sleep. Foundayo is an oral GLP-1, the same drug class as Zepbound, which Lilly already sells as an injection for weight management.

What the one-year trial found

In a one-year trial of patients who were not receiving PAP therapy, a form of ventilation, those on Foundayo saw a reduction of 17.8 events per hour on the AHI. The placebo group saw a reduction of 4.5 events per hour.

On the secondary measure, 28% of treated patients achieved remission or mild disease, compared with 13% in the placebo group. That is a doubling of the remission rate, and it is the figure most likely to end up on a slide in front of prescribers.

Why the Zepbound comparison matters

The honest headline here is the one STAT led with: the pill worked, and it worked less well than the shot. That is not a failure, but it does complicate the simplest version of the oral GLP-1 pitch, which has always been that a pill matches the injection without the needle.

For sleep apnea specifically, the question is how much efficacy patients and payers will trade for convenience. A pill that is easier to start and stay on could still move more people further than a more potent injectable that fewer people begin.

What the data do not settle

The trial reported was in patients not on PAP therapy, so it says nothing directly about people already using ventilation. STAT's account does not detail the second late-stage study, and no head-to-head trial against Zepbound is described.

Where this leaves Lilly

Lilly now has published, peer-reviewed evidence that an oral GLP-1 reduced AHI scores in a one-year trial, presented at a major cardiology meeting. What remains unsettled is whether a smaller effect delivered in pill form is the version of this drug that sleep apnea patients and their insurers actually want.