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Also: Wegovy · Rybelsus · sema · the skinny shot · semglutide
Four separate measurements, never averaged. Independent evidence counts only studies with no sponsor attached. Methodology version v2.0-2026-10 · how we grade evidence
Approved for chronic weight management in adults and adolescents with obesity, or adults with overweight plus a weight-related condition. It carries two further and separate approvals: reducing the risk of major adverse cardiovascular events in adults with established cardiovascular disease and overweight or obesity, and — under accelerated approval only — improving liver fibrosis in non-cirrhotic MASH.
Those three claims rest on three different trials and are not interchangeable. The weight claim comes from STEP 1, the cardiovascular claim from SELECT, and the liver claim from a surrogate endpoint whose clinical benefit remains unverified. Reporting that conflates them is common and wrong.
The weight effect is the largest of any GLP-1 agonist tested, and the trials behind it were designed, funded and analysed by the company that sells it. The independent synthesis that exists puts the one-year effect somewhat lower than the pivotal trial did, and quantifies a lean-mass cost alongside it.
At a glance
A long-acting analogue of glucagon-like peptide-1 that agonises the GLP-1 receptor. In the pancreas this produces glucose-dependent insulin secretion and glucagon suppression. The weight effect is attributed to central appetite and satiety signalling plus slowed gastric emptying, which reduces energy intake — all three directly demonstrated in human studies. Whether the cardiovascular benefit is mediated by weight loss is a separate and unresolved question.
Dated determinations, each flagged for whether it is final and whether it covers safety only. A safety review is not an efficacy finding, and most reporting in this category conflates the two.
Granted under accelerated approval, which means it rests on a surrogate endpoint and continued approval is contingent on a confirmatory trial. Clinical benefit is unverified.
A separate indication resting on a separate trial (SELECT). It covers reduction in the risk of cardiovascular death, non-fatal myocardial infarction and non-fatal stroke. It is not the weight indication and the two should not be reported as one.
Authorised 6 January 2022 for adults and for adolescents aged 12 and over. Marketing authorisation holder Novo Nordisk A/S.
Original approval 4 June 2021 for adults with obesity, or overweight with at least one weight-related comorbidity. Extended to adolescents aged 12 and over on 23 December 2022. Oral tablets followed on 22 December 2025 and a higher-dose injection presentation on 19 March 2026.
The effect is dose- and duration-dependent in rodents and its human relevance is undetermined. Labelled warnings also cover acute pancreatitis, acute gallbladder disease, severe gastrointestinal reactions, acute kidney injury from volume depletion, diabetic retinopathy complications, heart-rate increase, and pulmonary aspiration during general anaesthesia or deep sedation. A safety warning says nothing about whether the drug works.
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