Orforglipron is an oral, nonpeptide, small-molecule glucagon-like peptide-1 receptor agonist developed for type 2 diabetes and obesity. This narrative review evaluates its comparative positioning among marketed GLP-1 receptor agonists by integrating structural, pharmacological, clinical, and practical evidence. A narrative literature review was conducted using PubMed/MEDLINE, Embase, Scopus, Web of Science, ClinicalTrials, official prescribing information, and citation tracking. The synthesis was organized by comparative domains, including molecular structure, receptor pharmacology, early clinical pharmacology, direct comparative evidence, contextual comparator evidence, and practical administration. From 245 screened records, 88 duplicates were removed, 157 unique records were assessed, and 35 orforglipron-focused sources were retained. Seven additional comparator trials were selected through targeted citation verification because they represented clinically relevant benchmarks for oral semaglutide in type 2 diabetes and obesity, danuglipron as another oral small-molecule GLP-1 receptor agonist, and injectable semaglutide as a high-efficacy class comparator. Current evidence identifies several domains relevant to the comparative positioning of orforglipron, including its nonpeptide small-molecule structure, receptor pharmacology, once-daily oral dosing profile, and direct comparator evidence against dulaglutide and oral semaglutide. Food-effect and prescribing-information sources describe fewer food-related administration constraints for orforglipron than for oral semaglutide. However, indirect comparisons remain limited by differences in populations, doses, follow-up duration, comparators, and endpoints. At present, orforglipron should be viewed as an oral small-molecule GLP-1 receptor agonist with emerging comparative evidence, rather than as a broadly superior replacement for existing agents. Further long-term comparative, cardiovascular, renal, safety, adherence, and real-world effectiveness data are needed to define its final place in therapy.
