Novo’s Crown Slips — CagriSema Flops and Lilly Sprinted Past

Bloomberg, Reuters, and Market Watch contributed to this report.

Once the darling of the obesity-drug boom, Novo Nordisk just had a reality check. The Danish company’s next-gen shot, CagriSema, failed to beat or even match Eli Lilly’s tirzepatide in a head-to-head late-stage trial, and investors punished it hard — Novo shares plunged about 16% on the news.

Quick recap: Novo turned its diabetes hit semaglutide (known in weight-loss form as Wegovy) into a market-maker for injectable obesity drugs. That success helped vault the company to the top of Europe’s market cap charts. But Eli Lilly’s tirzepatide — the ingredient behind Zepbound/Mounjaro — has been stealing prescriptions and momentum.

The trial in question ran 84 weeks. Patients on CagriSema averaged 23% body-weight loss; those on tirzepatide posted 25.5%. That gap sank Novo’s hope that CagriSema would be the clear successor to Wegovy and a way to claw back market share.

Analysts didn’t hold back. Evan Seigerman told clients the company “literally ran a trial that said that Lilly’s product is better.” Other banks flagged that the result makes it much tougher for Novo to dislodge Lilly’s growing lead. Emmanuel Papadakis even asked during an investor call whether CagriSema was now “obsolete” as an upgrade over Wegovy.

Novo’s management pushed back. CEO Mike Doustdar called tirzepatide’s showing an “abnormality,” and Chief Scientific Officer Martin Holst Lange pleaded for patience, pointing to trial design quirks and plans for higher-dose tests. But after two high-profile CagriSema misses in a little over a year, investors aren’t buying optimistic footwork.

Why this matters

• Market share & momentum: Lilly has won a clinical edge and is currently taking the lead in US prescriptions. In a winner-takes-most category, even a couple percentage points of extra weight loss can decide who doctors prescribe and who patients choose.
• Commercial math: Without clear superiority on efficacy or tolerability, CagriSema may only compete on price — a tough spot given Novo’s need to defend margins and growth.
• Broader pressure: Novo isn’t just facing clinical competition. It’s wrestling with pricing pressure in the US., looming patent expiries for Wegovy/Ozempic in some markets, and an erosion of investor confidence after leadership churn and profit warnings.

Novo plans more trials, including higher-dose combinations, to try to show bigger wins. But analysts say regaining trust will be an uphill slog; some even argue Novo may need to pivot — through partnerships, acquisitions or a sharper focus on differentiating products — to stay competitive.

Novo built the market with Wegovy, but the next round of the obesity race is clinical, not just marketing. With CagriSema falling short and Lilly piling on wins, the crown is shakier than it looked — and reclaiming top spot will take more than pep talks from management.