Novo Nordisk’s glucagon-like peptide-1 receptor agonist (GLP-1RA) Wegovy (semaglutide) showed a significant reduction in cardiovascular (CV) events compared to Eli Lilly’s Zepbound (tirzepatide) in a real-world trial.
In data was presented at the European Society of Cardiology (ESC) Congress 2025 in Madrid, Spain, taking place from 29 August to 1 September, the STEER study found that compared with Zepbound, Wegovy showed a 57% greater risk reduction for heart attack, stroke and CV-related death or death from any cause, in people with overweight or obesity and cardiovascular disease (CVD), while on treatment with no treatment gaps more than 30 days.
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In all treated patients, regardless of any gaps in treatment, Wegovy showed a 29% risk reduction for heart attack, stroke and death from any cause compared with Zepbound over an average follow-up of 8.3 months for Wegovy and 8.6 months for Zepbound.
This amounted to 56 (0.5%) CV events with Wegovy and 83 events (0.8%) with Zepbound.
Anna Windle, senior vice president of Clinical Development, Medical and Regulatory Affairs at Novo Nordisk, said: “In the STEER study, patients using Wegovy had greater CV improvements compared to Zepbound, indicating that the same CV benefit cannot be generalised across other molecules in the GLP-1 or GIP/GLP-1 classes and may come specifically from the semaglutide molecule.”
The STEER study was a retrospective, observational, real-world study, evaluating the efficacy of Wegovy (semaglutide) 2.4mg versus Zepbound in lowering the risk of MACE in US adults with overweight or obesity and established cardiovascular disease with no prior history of diabetes. Each treatment group comprised 10,625 patients.
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By GlobalDataNovo and Lilly remain obesity and diabetes front runners
The two companies remain the front-runners in the subcutaneous type 2 diabetes and obesity space. Novo Nordisk’s drug is predicted to bring in $44.57bn in 2031, while Lilly’s drug is set to make $64.06bn in the same year, according to GlobalData.
GlobalData is the parent company of Pharmaceutical Technology.
Novo Nordisk’s lower sales may be in part due to the drug’s patent expiring in China in 2026. While patents protect the drug until 2031-2032 in seven major markets, China’s patent expiry paves the way for Chinese pharmaceutical companies to capitalise on this multi-billion-dollar market opportunity, according to GlobalData.
China is experiencing a rapid increase in both diabetes and obesity prevalence, largely driven by factors such as urbanisation, changes in dietary habits, and increasingly sedentary lifestyles.
Nadim Anwer, pharma analyst at GlobalData, said: “The semaglutide patent cliff in China represents a paradigm shift that will broaden access to life-changing GLP-1RA therapies while creating a new competitive landscape dominated by local players. It will drive increased competition and lower prices.”
It may also be linked to a head-to-head study, which showed Lilly’s drug to have a higher weight loss than Novo Nordisk’s.
This all comes as both Novo Nordisk and Eli Lilly are hoping to gain approval by the US Food and Drug Administration (FDA) for their oral GLP-1RA drugs, oral semaglutide and orforglipron, respectively.
While oral semaglutide did show higher weight loss than Lilly’s orforglipron in their respective Phase III trials, GlobalData analysts predict that Lilly’s oral candidate will benefit from higher sales should both drugs gain approval in the US.
