Novo’s Wegovy pill nears 22% weight loss

Novo Nordisk used new trial analyses this week to sharpen the case for a pill version of Wegovy as the obesity drug market moves beyond injections. At the European Congress on Obesity in Istanbul, the Danish drugmaker said some adults in its phase 3 OASIS 4 trial who responded early to oral semaglutide went on to lose nearly 22% of body weight by week 64. The data arrive as Eli Lilly presses its own case with head-to-head and oral-drug results that extend to 72 weeks, and as Washington pushes a most-favored-nation drug-pricing plan that explicitly mentions GLP-1 medicines. The result is a three-way contest over efficacy, convenience and price. ### How close is Novo’s pill to injectable-style weight loss? Novo Nordisk said on May 13 that adults in OASIS 4 who were classified as early responders to oral semaglutide 25 mg reached 21.6% weight loss by week 64. The company defined early responders as patients who had lost at least 10% of body weight by week 16, and said that group also showed larger gains on a physical-function measure than later responders. (novonordisk.com) The OASIS 4 trial itself was a 64-week, randomized, placebo-controlled study in 307 adults across Canada, Germany, Poland and the United States, according to Novo trial materials. Participants received once-daily oral semaglutide 25 mg or placebo on top of lifestyle intervention after a 12-week dose-escalation period. (novonordisk.com) Earlier OASIS 4 results showed average weight loss of about 14% under the trial’s treatment-regimen analysis and about 17% if all patients stayed on treatment, figures that helped support the pill’s U.S. launch in January 2026, according to Novo materials and company statements. The new analysis does not replace the main trial endpoint, but it shows how far a subset of patients can go over 64 weeks. (sciencehub.novonordisk.com) ### What is Lilly showing against semaglutide? The New England Journal of Medicine published SURMOUNT-5 results on July 3, 2025, showing tirzepatide produced greater weight loss than semaglutide at week 72 in adults with obesity and no diabetes. The study reported that tirzepatide was superior on both body weight and waist circumference in the phase 3b head-to-head trial. (prnewswire.com) Lilly has used those data to argue that Zepbound, its tirzepatide product, sets a higher efficacy bar in obesity. Company materials tied to the publication said participants on tirzepatide lost 20.2% on average versus 13.7% on semaglutide, and were more likely to hit thresholds of 10% through 25% weight loss. (nejm.org) Those numbers matter because Novo’s oral semaglutide result is being judged in a market where Lilly already has a stronger injectable showing over a longer 72-week follow-up. Any comparison across trials remains indirect unless tested head-to-head, and neither company’s trial design makes the oral-versus-injectable question definitive. (prnewswire.com) ### How strong is Lilly’s oral challenger? Lilly said on Aug. 7, 2025, that its phase 3 ATTAIN-1 trial of oral orforglipron met its primary and key secondary endpoints in 3,127 adults with obesity or overweight without diabetes. At 72 weeks, the highest dose cut weight by 12.4% on average versus 0.9% for placebo, and 39.6% of participants on that dose lost at least 15% of body weight. (nejm.org) Lilly has since moved beyond initial weight loss to maintenance data. Company materials for ATTAIN-MAINTAIN said the study tested once-daily orforglipron against placebo for maintaining weight reduction after prior treatment with injectable incretins, alongside similar maintenance data for Zepbound. By May 2026, Lilly’s obesity pill was no longer only a pipeline asset. (investor.lilly.com) NEJM’s clinician summary said the U.S. Food and Drug Administration approved orforglipron, branded Foundayo, in April 2026 for obesity and overweight, making it the second oral GLP-1 option after semaglutide. ### Where does Washington enter the obesity-drug fight? (investor.lilly.com) The White House said on May 5, 2026, that its most-favored-nation pricing framework would apply to new branded drugs across U.S. markets and to existing drugs in state Medicaid programs. The administration projected $529 billion in domestic savings over 10 years from prospective pricing rules and $64.3 billion in federal and state savings from Medicaid pricing on existing drugs. (clinician.nejm.org) The same White House paper named GLP-1 drugs directly. It said discounted direct-to-consumer prices would generate savings for patients buying weight-loss GLP-1s outside insurance, estimated uninsured-user savings at $3,000 a year, and said the administration had secured GLP-1 price reductions to support a broader Medicare anti-obesity benefit. (whitehouse.gov) President Donald Trump’s May 12, 2025 executive order laid out the policy goal of giving Americans access to a most-favored-nation price and directed agencies to pursue further action if manufacturers did not comply. The White House also said it is working with Congress to codify voluntary agreements with drugmakers into law. (whitehouse.gov) ### What should readers watch next? Novo Nordisk’s next test is whether post-hoc OASIS 4 analyses translate into durable prescribing momentum for oral Wegovy after its January 2026 U.S. launch. Lilly’s next milestone is the continued rollout of Foundayo and additional maintenance and comparative data as physicians decide how much convenience they will trade for efficacy. (whitehouse.gov) Congress and the administration will shape the reimbursement side. The White House said on May 5 that it wants to codify MFN agreements and ensure insurers count direct-to-consumer (prnewswire.com)