Novo Nordisk Faces Investor Pressure Over Pipeline Concentration as ZEUS Failure and Ziltivekimab Setbacks Mount

Top holders Baillie Gifford and Flossbach urge Novo Nordisk to diversify beyond Ozempic and Wegovy ahead of its Capital Markets Day.

Novo Nordisk's reliance on a narrow band of blockbuster medicines is drawing mounting scrutiny from institutional shareholders, just as a string of clinical disappointments and an approaching strategy summit sharpen questions about where future growth will come from.

More than 90% of group revenue currently flows from Ozempic and Wegovy, the two GLP-1 treatments that have powered the Danish drugmaker's rise. That concentration sits uneasily alongside an expected sales decline of as much as 6% for the current financial year, and with the first patent expirations on semaglutide already looming in markets including India, Brazil, Canada and Turkey. Protection in Europe and the US does not lapse until the 2030s, but the approaching cliff in emerging economies is concentrating minds.

Baillie Gifford and Flossbach Push for Deals

Ahead of Monday's investor gathering, major holders are pressing for faster diversification through acquisitions and partnerships. Julia Angeles, a manager at top shareholder Baillie Gifford, said the company must set out a coherent path out of its dependence on Ozempic, leaving the door open to tie-ups on experimental treatments. Eugen Uretzki, an analyst at Flossbach, added that Novo has yet to prove the development potential of the assets already on its books.

The debate has taken on added urgency after recent setbacks in late-stage research. In the Phase 3 ZEUS trial, the company's hoped-for candidate Ziltivekimab missed its primary endpoint for reducing cardiovascular risk in patients with atherosclerotic disease, chronic kidney disease and systemic inflammation. Management expects a non-cash impairment in the third quarter as a result, though its adjusted operating profit guidance for the full year remains untouched.

Mixed Late-Stage Results

The ZEUS miss is not the only blemish. On 7 September, Novo reported data from the late-stage STEP Young study of semaglutide, in which 40.4% of children aged six to under twelve were no longer classified as obese after 68 weeks when fully adherent to treatment. The trial met its primary endpoint for reducing body mass index.

On the same day, however, the group halted two additional Ziltivekimab studies in heart failure, according to Reuters. An independent data monitoring committee concluded there was only a low probability of a different outcome from an earlier, unsuccessful late-stage trial. A separate study in patients who have suffered a heart attack continues, with results expected in the first half of 2027.

Orbis Deal and a Broader Pipeline

To widen its future treatment range, Novo is leaning on partnerships. Reuters reported on Thursday that the company had struck a drug discovery and licensing agreement with Orbis Medicines worth up to $1.4bn, focused on oral approaches to cardiometabolic disease. Novo is also taking a strategic stake in Orbis as part of the arrangement.

The research push comes alongside organisational changes. Since 14 September, the company has used the shortened name "Novo" in day-to-day business and introduced an internal strategy dubbed "The Novo Way", while "Novo Nordisk A/S" remains the legal name. Under CEO Mike Doustdar, a restructuring drive has already cut more than 9,000 jobs.

Milan Data and a London Summit

Further scientific detail is due at the EASD 2026 congress in Milan, scheduled for 28 September to 2 October, where Novo said on Wednesday it will present new data from its cardiometabolic portfolio. Additional business details are flagged for 21 September at the Capital Markets Day.

In the market, the shares closed Friday at EUR 37.58, down 15% since the start of the year and 31% below their 52-week high. Whether management can offer convincing answers on Monday to the pressing questions about its future growth strategy is likely to prove decisive for the stock's next move.