Reality Check
I will just say up front, I am a Novo investor of 20+ years, it's my largest position by far and I've added plenty since the Q1 drop.
Let's go through the good and the bad and have a look at what Novo actually needs to do, because some of the cheerleading today is a bit baffling. I even see comments declaring Wegovy "best in class" which is frankly delusional.
The Bad:
CagriSema failed non-inferiority against tirzepatide in REDEFINE 4 on 23 February. 23% vs 25.5% weight loss at 84 weeks on the efficacy estimand, 20.2% vs 23.6% on the treatment-regimen estimand meaning the primary endpoint was not met. This confirmed what the cross-trial data already suggested, that the GLP-1/amylin mechanism cannot match GLP-1/GIP dual agonism on weight loss and we should expect no better from Amycretin.
Novo's response has been to escalate semaglutide dosing. Wegovy HD (7.2mg) was approved in March, launched in April, but let's use the correct numbers. The STEP UP label figure, the treatment-regimen estimand published in the Lancet (Wharton et al., 2025), is 18.7% weight loss at 72 weeks. The 20.7% figure Novo uses in press materials is the on-treatment estimand, which excludes people who dropped out. Zepbound's label is 20.9%, so the gap has not closed and the tolerability cost of tripling the dose is severe, with GI adverse events above 70% of participants, plus a new dysaesthesia signal at roughly 23%. Today's ECO sub-analysis showed that early responders, 27% of patients hit 27.7%, but the other 73% averaged only 15.4%, so most patients on Wegovy HD are getting results below Zepbound's population average. That is just the truth, inconvenient as it may be to some.
And of course the stock reflects Novo's pipeline challenge, trading at roughly $47 down about 67% from the June 2024 high of $142 with a P/E of around 11x versus Lilly at roughly 34x.
The Good:
The Wegovy pill launch is the strongest GLP-1 launch in history with over 2 million cumulative prescriptions since the 5 January launch. Q1 revenue of DKK 2.26 billion ($354 million) is more than double what analysts expected. Weekly scripts exceeded 200,000 by mid-April and the Wegovy brand now holds ~65% of new US prescriptions. Injectable Wegovy revenue grew 12% year-on-year alongside the pill, which confirms that oral is pulling in new patients rather than cannibalising the existing injectable base. That's fantastic and no doubt sell-side analysts everywhere feel pretty stupid.
The body composition data from STEP UP deserves attention too. An MRI sub-study presented at ECO today showed 84% of weight lost on semaglutide was fat mass, with muscle function preserved and visceral fat reduced by over 30%. It's a small sample (n=55), and it needs replication, but if it holds it gives Novo a potentially genuine differentiator even when the headline weight loss numbers don't match tirzepatide.
Novo's balance sheet remains stellar: DKK 309 billion in 2025 revenue, DKK 102 billion net profit, with comfortable M&A firepower over $60 billion.
So what needs to happen?
Novo's internal next-generation assets cannot close the competitive gap in time. Even if UBT251 (GLP-1/GIP/glucagon) and NN419 (GLP-1/GIP/amylin) turn out to be the most promising molecules in all of obesity (which would be quite something), Phase 3 trial initiation in the US wouldn't happen for years, and obesity Phase 3 trials run 72 to 84 weeks minimum. At least that's the SURMOUNT, STEP UP, and REDEFINE precedent. Add regulatory review and you're looking at US approval well into the 2030s. Semaglutide goes generic in 2032..
So Novo cannot wait. CagriSema isn't going to cut it even if you fold it into the Wegovy brand and call it "Wegovy Awesome". M&A is coming because it has to, and that's not a bad thing either. Doustdar knows this and has already signalled up to $40 billion in M&A spend. Novo's BD team ran 200 meetings at the JPM conference with a mandate to go "very big" on acquisitions. After Q1 results last week he told CNBC he's "always open to doing deals" and that Novo needs "not just the best, but the broadest pipeline in the world."
The real inflection point for the stock is whether management acquires a next-gen molecule with GIP activity before the competitive window closes. That is, if Mike is serious about having "the broadest pipeline in the world". The organic path does not get there fast enough while the pill is buying time brilliantly. Whether that time gets used wisely should inform your entire investment thesis from here on out.