Novo's OCTANE real-world study: switchers from injectable GLP-1s to the Wegovy pill lost about 4% more weight

Novo Nordisk presented real-world data on Sept. 30 at the European Association for the Study of Diabetes (EASD) meeting in Milan showing that people who switched from a weekly GLP-1 injection to the Wegovy pill kept losing weight over the following three months ^[1][2].

The analysis, called OCTANE, used data from Ro's telehealth platform covering 194 adults with obesity or overweight, about 56% of them female ^[1]. Half had started on Novo's Wegovy injection (semaglutide) and the rest had started on Eli Lilly's Zepbound (tirzepatide) ^[1]. All of them later switched to oral semaglutide, sold as the Wegovy pill.

Among patients who switched and stayed on the pill for three months, average weight loss was roughly 4% of body weight, or an additional 8.8 pounds ^[1]. That was measured from an average starting weight of about 221 pounds at the time they began the pill, according to Novo ^[1]. Two in five of those participants lost 5% or more of their body weight three months after switching ^[1]. The share of people with a body mass index at or above 30 fell by more than 21% over the same period ^[1].

What the study can and cannot show

OCTANE has no control group, so it cannot show that the pill caused the added weight loss. Real-world studies of this kind evaluate associations rather than cause and effect ^[1]. Novo listed several other limitations: the timing and completeness of data gathered during routine telehealth care varied, self-reported information is subject to bias, and the results are "not being generalizable to the broader population" ^[1].

Patient-reported findings were also part of the analysis. Among those with available data, about 82% reported at least one improvement while on the pill, including nearly 70% who said clothes fit better and about 51% who said they pursued healthier eating ^[1]. Roughly 75% said they were satisfied with the switch to a pill ^[1].

Martin Holst Lange, Novo's chief scientific officer, said in an interview that subcutaneous Wegovy "can now be interchanged with a tablet of Wegovy, and the patient can expect the same tolerability profile, the same safety profile, and actually a little bit more weight loss" ^[1]. He also said the company now sees "a preference for orals" among patients, pointing to people who travel often and do not want to think about refrigerating injections ^[1]. Those are company characterizations, not findings from a randomized trial.

The OCTANE results were scheduled as a short oral discussion at EASD on Sept. 30, under the title "3-month real-world weight outcomes among patients with overweight or obesity after switching from injectable semaglutide or tirzepatide to oral semaglutide for weight management" ^[2].

Why it matters for patients

The oral-versus-injectable question is new in practice. Novo's Wegovy pill made its US debut in January, with a starter dose launching at $149 a month for cash-paying patients ^[3], and Lilly's oral GLP-1 Foundayo (orforglipron) was approved for obesity in April ^[3]. Many people now on weekly shots are weighing whether a daily tablet is a reasonable alternative.

What OCTANE suggests is that, in one telehealth population, switching did not appear to stall progress over three months. What it does not answer is how the pill compares with staying on the original injection, because no group stayed on injections for comparison ^[1]. Longer-term results beyond three months have not been reported, and the analysis does not break out how outcomes differed between people who came off Wegovy shots and those who came off Zepbound.

Separately at the same meeting, Lilly presented an indirect comparison — not a head-to-head trial — arguing that Foundayo at 17.2 mg was tied to 1.5% greater average weight loss and 0.3% greater A1C reduction than the Wegovy pill at 25 mg in type 2 diabetes, with a range of 1.5% to 2.4% and 0.3% to 0.6% across methods ^[3]. Foundayo has not yet received FDA clearance for type 2 diabetes ^[3]. Whether any of these datasets change coverage rules or prescribing patterns has not been established.

Decisions about switching involve dosing, cost, insurance and side effects that vary by person, and are handled with a prescriber.