Novo Nordisk (NYSE:NVO) presented retrospective real-world evidence comparing cardiovascular outcomes among adults with type 2 diabetes who increased their once-weekly semaglutide injection from 1 mg to 2 mg with those who switched from semaglutide to tirzepatide.
The analysis, presented at the European Association for the Study of Diabetes Annual Meeting 2026 in Milan, Italy, included 636,525 adults who were initially treated with semaglutide 1 mg.
According to Novo Nordisk, patients who escalated to semaglutide 2 mg had a statistically significant 6% lower risk of major adverse cardiovascular events, or MACE, compared with patients who switched to tirzepatide at doses of up to 15 mg.
MACE in the analysis included all-cause death, heart attack and stroke. The reported adjusted hazard ratio was 1.06, with a 95% confidence interval of 1.04 to 1.08 and a P-value of 0.005.
Study Tracks Treatment Changes Over Two Years
Within 365 days of their first semaglutide 1 mg prescription, 67.2% of patients remained on that dose, while 29.2% had increased their dose to semaglutide 2 mg and 3.6% had switched to tirzepatide.
At the 720-day follow-up, 57.4% remained on semaglutide 1 mg, 36.9% had escalated to the 2 mg dose and 5.7% had switched to tirzepatide.
Approximately 31% of patients who switched to tirzepatide reached a dose of at least 10 mg during the follow-up period.
Novo Nordisk Notes Limitations of Retrospective Analysis
Novo Nordisk said the findings are subject to limitations associated with retrospective real-world studies.
These include the potential for residual unmeasured confounding, reliance on claims data and limitations on how broadly the findings can be applied.
The observational design also means the analysis cannot establish that the choice of treatment caused the difference in cardiovascular outcomes.
Safety outcomes were not evaluated as part of the analysis.
Semaglutide Carries Boxed Warning
Semaglutide injection carries a Boxed Warning concerning the potential risk of thyroid tumours, including cancer.
It is contraindicated in patients with a personal or family history of medullary thyroid carcinoma or Multiple Endocrine Neoplasia syndrome type 2.
Common reported side effects include nausea, vomiting, diarrhoea, abdominal pain and constipation.