Danish drugmaker Novo Nordisk built an early empire on the back of semaglutide, the active ingredient powering both its blockbuster Ozempic and Wegovy treatments.
Ozempic was originally developed to treat type 2 diabetes before patients and physicians discovered its dramatic weight-loss effects, setting off a global pharmaceutical gold rush.
Novo rebranded semaglutide as Wegovy specifically for weight management, riding that wave to briefly become the most valuable publicly listed company in all of Europe.
That dominance has since crumbled, with Eli Lilly seizing the initiative through tirzepatide, marketed as Mounjaro for diabetes and Zepbound for obesity-related weight loss.
Lilly’s tirzepatide demonstrated higher efficacy than semaglutide in clinical comparisons, giving the American drugmaker a meaningful medical and commercial edge over its Danish rival.
Novo now controls only around 40% of the GLP-1 market, while Eli Lilly commands roughly 60%, a dramatic reversal for a company that pioneered the category.
Making matters worse, a trial of Novo’s next-generation drug failed to outperform Eli Lilly’s existing medication, sending Novo shares into a steep decline of roughly 80% from their 2024 peak.
The global GLP-1 market is currently valued at approximately $72 billion and is widely expected to double by 2030, raising the stakes considerably for every player involved.
Novo has also faced mounting pricing pressure from cheap copycat versions of its drugs circulating in various markets, forcing the company into a damaging price war it did not anticipate.
Both Novo and Lilly reached a deal with the Trump administration to lower prices on their GLP-1 drugs through Medicare and Medicaid, squeezing margins at a particularly difficult moment.
The United States has accounted for more than half of Novo’s total sales since 2023, meaning any deterioration in American pricing directly threatens the company’s overall financial performance.
The competitive landscape is broadening further, with Amgen, Roche, AstraZeneca, Viking Therapeutics, and Structure Therapeutics all advancing oral therapies, combination drugs, and novel treatment mechanisms.
Novo has attempted to reclaim lost ground in Europe after winning European Commission marketing authorisation for oral Wegovy, making it the first and only GLP-1 pill approved for weight management on the continent.
The company’s most advanced pipeline candidate is CagriSema, a fixed-dose combination of a long-acting amylin analog and semaglutide, for which Novo filed a new drug application with the FDA in December 2025.
Whether CagriSema and the oral Wegovy approval are enough to reverse Novo’s fortunes remains an open and pressing question for investors watching the high-stakes obesity drug market closely.
