B
Competitive
Injectable division · GLP-1 mono
Semaglutide 2.4 mg
Novo Nordisk · Wegovy · once weekly
Approved
Division standing
#4 of 5
Injectable division
← Tolerability cost (bands)% body weight lost →
Mild012% vs placebo
Tolerability: the cost
Mild7% vs 3.1% placebo
AE-discontinuation +3.9 points, at the 2.4 mg weekly. From STEP-1.
Efficacy
12%2.4 mg · placebo-adjusted · 68 wk
STEP-1: 14.9% vs 2.4% placebo, a 12-point gap on the treatment policy estimand.
Wegovy HD · 7.2 mg weeklyApprovedConditional higher doseNot separately ranked
STEP UP found 18.7% average weight loss with 7.2 mg versus 15.6% with 2.4 mg and 3.9% with placebo on the treatment-policy estimand: 3.1 percentage points more than 2.4 mg, and 14.8 points versus placebo. The FDA label allows 7.2 mg only after tolerating 2.4 mg for at least four weeks and when additional weight reduction is clinically indicated. The board scores 2.4 mg, the highest standard maintenance dose reached through the usual labeled escalation; Wegovy HD is approved context, not a separate verdict.The drug that opened the era, and still the baseline every newcomer is measured against.
At the 7.2 mg dose, 22.9% of people in STEP UP reported altered skin sensation, against 6.0% at 2.4 mg and 0.5% on placebo. Our tolerability score counts only those who stop the drug, and few stopped over this, so the score does not reflect it.
Convenience profile: you weigh it, not us
Route
Subcutaneous injection
Frequency
Once weekly
Food / water rule
None
Titration
Usual labeled escalation to 2.4 mg over 16 weeks; 7.2 mg may be considered after at least 4 weeks at 2.4 mg
Storage
Refrigerated (room temperature up to 28 days)
Provenance: every number traces back
TrialSTEP-1 · NCT03548935
Estimandtreatment policy estimand
Populationnon-diabetic obesity
Dose2.4 mg weekly
SourceWilding NEJM 2021; STEP UP, Lancet Diabetes Endocrinol 2025; FDA Wegovy prescribing information, revised Mar 2026
Verdict confirmed25 Aug 2026
Compare Semaglutide 2.4 mg against:RetatrutideTirzepatideCagriSemaSurvodutideOral semaglutideOrforglipron