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These medications are contraindicated in pregnancy and require discontinuation before conception (approximately two months for semaglutide)

What the FDA Requires in the BLA Efficacy Data: TRIUMPH-4: 28.7% weight loss Complete TRIUMPH-1: 28.3% weight loss Complete TRIUMPH-2: 20.8% weight loss (obesity + diabetes) Complete TRIUMPH-3: 22.6% weight loss (obesity + cardiovascular disease) Complete, MACE data not statistically significant Safety Data: Side effect profile across all four populations Short-term and medium-term adverse events, including the dysesthesia signal (up to 20.9% at 12mg) Drug interactions, especially with diabetes medications Manufacturing Data: Scale-up capability for millions of doses per month Quality control and stability data Cold chain distribution logistics Realistic Approval Scenarios With the BLA filing point now expected (Q1 2027), the remaining uncertainty is largely in the FDA review itself not in whether or when Lilly files

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Blood glucose control in healthy subject and patients receiving intravenous glucose infusion or total parenteral nutrition using glucagon-like peptide 1