CagriSema: A Steep Price for Overpromising

Only a little more than a month ago, Novo Nordisk told Reuters that yes, they really did expect their next generation obesity drug, CagriSema, to deliver 25% weight loss in clinical trials. Then Thursday, the company disclosed topline results of 23% weight loss. Almost immediately, company’s stock price plunged by more than 20% – a steep price to pay for overpromising on clinical effectiveness for CagriSema.

Phase 3 Results

This was a pivotal phase 3 randomized controlled trial with 3,417 patients. The topline number of 23% weight loss comes from a trial product estimand, which is an estimate of the drug effect with full adherence to the treatment regimen.

The treatment policy estimand is a more conservative estimate that reflects actual adherence in the trial. By that measure, CagriSema yielded 20% weight loss, while semaglutide yielded a 15% weight loss.

These numbers are very similar to the recent toplines from Lilly in a trial comparing tirzepatide to semaglutide. In that trial, tirzepatide yielded 20% weight loss and semaglutide yielded 14% by the treatment estimand method.

So these results for CagriSema seem roughly similar to the numbers for tirzepatide. But of course, a direct comparison is simply not possible at this stage.

High Stakes

What is now clear is that the stakes in this market for obesity medicines are very high. Competition is heating up. With these results for CagriSema and the steep drop in the Novo’s stock price, we have a vivid illustration of just how costly overpromising can be.

This is a textbook illustration for the advice to underpromise and overdeliver. In the blink of an eye, $125 billion disappeared from the value of Novo Nordisk stock. Simply because the company did not follow that simple advice for managing expectations. Live and learn.

Click here, here, and here for more on the topline results with CagriSema.

A Maiden’s Tears, fountain sculpture in the Łódź Palace garden, photograph by Scotch Mist, licensed under CC BY-SA 4.0

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December 23, 2024