Novo Nordisk Strengthens Semaglutide Defense with Real-World Data as Pipeline Awaits Judgment

Novo Nordisk unveils real-world evidence challenging Eli Lilly's tirzepatide, advances CagriSema and Zenagamtide, and slashes Wegovy price for Medicare patients.

The pressure on Novo Nordisk shows no sign of easing. Shares closed at €37.27 on Friday, down around 1% on the day and roughly 16% since the start of the year. The stock now trades almost 47% below its 52-week peak of €70.13, a stark reminder of the competitive threat from Eli Lilly’s tirzepatide franchise. But the Danish drugmaker is entering a critical week armed with fresh ammunition — a batch of real-world evidence and a pipeline update designed to win back investor confidence.

The centerpiece of the new data is the COMPETE SWITCH analysis, presented at the ADA conference in New Orleans. Using a large U.S. claims database covering January 2018 to September 2025, researchers tracked what happened when type-2 diabetes patients on semaglutide 1 mg either switched to tirzepatide or increased their semaglutide dose to 2 mg. Among nearly 55,550 patients who escalated the semaglutide dose, 74.7% achieved an HbA1c below 7% after one year — almost identical to the 75.1% rate in the tirzepatide group. On weight loss, semaglutide actually outperformed: 60.5% of patients lost at least 5% of body weight, versus 55.3% on tirzepatide. Novo Nordisk itself cautioned that the data come from billing records, not controlled trials, so only associations — not causation — can be drawn. Still, the study gives doctors a reason to keep patients on semaglutide rather than automatically switching to Eli Lilly’s drug.

Beyond the real-world evidence, Novo Nordisk is betting its pipeline can reignite growth. The combination therapy CagriSema is under the microscope after earlier obesity data showed a 23% weight reduction, lagging the 25.5% seen with Zepbound. At the ADA conference, the company is presenting phase-3 results for CagriSema in type-2 diabetes, covering both blood sugar control and weight. Early February data were encouraging: patients lost 14% of body weight and saw a 1.9 percentage-point drop in blood sugar. Novo Nordisk anticipates U.S. regulatory approval in the fourth quarter, but the stigma of the previous miss will hang over the compound until full results are disclosed.

A brighter spot comes from the early-stage candidate Zenagamtide. Phase-2 results showed the highest dose lowered long-term blood sugar by 1.71 percentage points over 36 weeks, with nearly 89% of participants reaching the clinically relevant HbA1c target. Novo Nordisk is moving swiftly: a phase-3 program for adults with type-2 diabetes will begin in the second half of the year, though first readouts are not expected until 2028.

Meanwhile, the company is working to expand access to its existing blockbuster Wegovy. Starting July 1, eligible Medicare patients will be able to get the drug with a copay of just $50 per month, after Novo Nordisk accepted a net price of $245 per month — roughly an 80% discount off the list price. The move opens the door to a massive patient population. Novo Nordisk is also presenting new analyses suggesting benefits of semaglutide in sleep apnea and asthma, though neither indication has approval yet.

On the financial front, the company continues to prop up its stock through a buyback programme of up to 15 billion Danish kroner. By the end of May, it had repurchased nearly 18 million B-shares. But the top-line outlook remains cautious: management forecasts a 4% to 12% decline in both revenue and operating profit for the full year. Adjusted revenue in the first quarter fell 4% at constant currencies, though the obesity division grew 22%.

The stock is trading above its 50-day moving average of €35.80 but well below the 200-day line of €41.66, a level that now serves as a key resistance. All eyes will be on the market’s reaction when European exchanges open on Monday. The ADA presentation — along with additional analyses from the SELECT, STEP, ESSENCE and OASIS programmes — will either mark a turning point or confirm that the competitive headwinds are stronger than the company’s pipeline can counter. The next major check-in comes with second-quarter results in August.