Novo Nordisk's new 25% CagriSema figure counts only women who never quit; Zepbound's 25.5% stands
Novo Nordisk republished CagriSema as a women's-health win on October 20: 25% average weight loss in a post-hoc subgroup, computed as if no patient quit treatment. The FDA decides this quarter on the file that lost the head-to-head to Zepbound.
Richard Tang · 3 min read
On October 20 Novo Nordisk−0.24% — Novo Nordisk, down 0.24 percent today presented two post-hoc analyzes of REDEFINE 1, the phase 3 behind its US filing for CagriSema, the once-weekly injection pairing semaglutide, Wegovy's active ingredient, with cagrilintide, a long-acting copy of the satiety hormone amylin 1. Among the trial's women, average weight loss came to 25.0% at week 68 1.
The qualifiers are the story: the figure assumes every patient stayed on treatment, and it counts only the women in a trial that was two-thirds female and whose full-population answer, on the same assumption, was 22.7% 12. Novo's own release files the analyzes as hypothesis-generating 1.
Both of Novo's headline numbers assume nobody ever quits. The new one assumes you only count the women.
It lands just under the number that beat CagriSema
The problem being managed is REDEFINE 4, the only direct comparison with Lilly's−0.85% — Lilly, down 0.85 percent today Zepbound: CagriSema 23.0%, Zepbound 25.5% at 84 weeks, non-inferiority failed 2. The women's re-analysis lands half a point under Zepbound's figure, a gap no head-to-head ever measured. CagriSema does beat Novo's own medicine, with semaglutide alone at 19.0% in the same women 1; the gap it has not closed is Lilly's. FactSet+2.44% — FactSet, up 2.44 percent today consensus still carries $11.84 billion of CagriSema obesity sales in 2028 3.
Novo's new 25% for women sits just under the 25.5% Zepbound beat it with
Data
| Value | |
|---|---|
| CagriSema, REDEFINE 1 full trial (68 wks) | 22.7% |
| Semaglutide alone, same women (68 wks) | 19.0% |
| CagriSema, women post hoc (68 wks) | 25.0% |
| CagriSema, head-to-head (84 wks) | 23.0% |
| Zepbound, head-to-head (84 wks) | 25.5% |
Lilly's number is growing while Novo's is recomputed
Lilly's counter, presented three weeks ago, adds its own amylin copy, eloralintide, to tirzepatide, Zepbound's ingredient: 23.3% average weight loss at 48 weeks in phase 2, against 14.8% for tirzepatide alone, in the harder-to-treat population that also has Type 2 diabetes 45. Citi+1.00% — Citi, up 1.00 percent today reads that as comparable to tirzepatide's effect in people without diabetes, with phase 3 starting before year end 5. The catch is tolerability: up to 27% of patients on the combination discontinued 5. Lilly's first-half revenue grew by half; Novo's adjusted sales grew 2% 2.
The quarter belongs to the pill, and the cushion is nearly spent
San Diego moves nothing before the FDA rules. Novo reports on November 4 with consensus earnings down about a fifth year on year, after estimates were cut by a tenth within a month 67. BMO warns that a gross-to-net adjustment worth more than DKK 2 billion will make the US Ozempic decline look steeper than the underlying trend 7.
The upside is oral Wegovy, where Citi expects DKK 5.3 billion against a DKK 4.5 billion consensus and has lifted its peak forecast for the tablet to $13 billion 8. The 15-billion-kroner buyback is almost three-quarters spent 9, on a stock down 22% this year 7.
Novo built a better version of its own drug. It has not built a better drug than Lilly's, and a recomputed subset does not count as one.
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