Novo, Lilly Face Off Over Diabetes and Obesity Drugs as GLP-1 Competition Heats Up

Novo Nordisk and Eli Lilly are facing off over the superiority of GLP-1 drugs in the diabetes and obesity treatment market.

According to Fierce Pharma on the 29th (local time), the companies each presented comparative data on oral and injectable GLP-1 drugs at the European Association for the Study of Diabetes (EASD) 2026 annual meeting in Milan, Italy.

Novo Nordisk claimed its diabetes drug Ozempic was more effective at reducing the risk of major adverse cardiovascular events (MACE) than Lilly’s competing drug Mounjaro among patients who switched to it.

According to a real-world data analysis Novo Nordisk announced on the 29th, patients with type 2 diabetes who increased their Ozempic dose from 1mg to 2mg had a 6% lower risk of MACE than patients who switched to Lilly’s Mounjaro 15mg.

MACE included death from any cause, myocardial infarction and stroke, and the company said the 6% risk reduction was statistically significant.

The analysis included 636,525 adults with type 2 diabetes who began treatment with Ozempic 1mg. Within 1 year of starting their prescriptions, 67.2% remained on 1mg, 29.2% increased their dose to 2mg and 3.6% switched to Mounjaro.

Michael Radin, Novo Nordisk’s medical affairs executive, said, “Patients with type 2 diabetes often need to switch medications or adjust doses to control their blood sugar,” adding that “cardiovascular risk should remain an important consideration.”

Lilly countered by releasing indirect comparison results showing that its oral GLP-1 drug Foundayo was more effective for weight loss and blood sugar control than Novo Nordisk’s Wegovy pill.

Lilly said an indirect comparison of its ACHIEVE-3 trial and Novo Nordisk’s PIONEER PLUS trial found that patients taking Foundayo 17.2mg lost an average of 1.5% more body weight and lowered their glycated hemoglobin (A1C) by 0.3% more than patients taking Wegovy pill 25mg.

Depending on the analysis method, Foundayo was found to reduce body weight by 1.5% to 2.4% more and lower A1C by 0.3% to 0.6% more.

Rachel Batterham, Lilly’s senior vice president of medical innovation for cardiometabolic health, said, “The best way to compare two drugs is a head-to-head trial, but when data are not yet available, other approaches can provide useful information.”

Lilly also released indirect comparison results showing that its obesity injections Zepbound 10mg and 15mg produced greater weight loss than Novo Nordisk’s higher-dose Wegovy (Wegovy HD).

In the analysis, adults with obesity who used Zepbound lost an average of 4.5% more body weight at 72 weeks than patients who used Wegovy HD. For Zepbound 10mg, the average weight-loss advantage was 3.2%.

However, Lilly said that under an efficacy estimand assessing effects before treatment discontinuation, Zepbound 15mg and 10mg produced only 1.8% and 0.7% greater weight loss, respectively, than Wegovy HD, and the differences were not statistically significant.

Thomas Seck, Lilly’s senior vice president of product development for cardiometabolic health, said, “In a head-to-head phase 3 trial, Zepbound 10mg and 15mg produced greater weight loss than Wegovy,” adding that “the new indirect comparison suggests that Zepbound at the same doses may also outperform Wegovy HD.”

Meanwhile, Lilly is also evaluating the potential to expand Foundayo’s indications to include obstructive sleep apnea, knee osteoarthritis pain, hypertension, peripheral artery disease and stress urinary incontinence.