The GLP-1 war has finally ended and a new leader has emerged.
In its 2025 performance report released on February 4th, Eli Lilly showed that the combined sales of its two major brands, Mounjaro and Zepbound, reached 36.507 billion US dollars for the entire year. Among them, Mounjaro contributed 22.965 billion US dollars, and Zepbound contributed 13.542 billion US dollars. Almost simultaneously, Novo Nordisk's 2025 financial report disclosed that Ozempic sold 127.089 billion Danish kroner, Rybelsus sold 22.093 billion Danish kroner, and the revenue from the obesity business was 82.347 billion Danish kroner. Based on the disclosed figures, the sales of the semaglutide system for the entire year have approached 3.3 billion US dollars, but it has been surpassed by Trelleborg. That is to say, if calculated by the molecular scale rather than the single brand scale, Trelleborg has taken the position of the world's best-selling drug.
This is not merely a simple product overtake; rather, it marks a true turning point in the landscape of the GLP-1 industry.
Over the past two years, semaglutide has almost defined the global weight loss drug market. It first broke into the diabetes market with Ozempic, and then used Wegovy to push weight loss drugs into the mainstream consumer healthcare sector. This not only established doctors' recognition but also educated the capital market. Novo Nordisk was once the biggest winner in this round of GLP-1 craze, and even once rewrote the valuation ceiling of European pharmaceutical companies with semaglutide. But by 2025, Eli Lilly brought this battle into the second stage: no longer was GLP-1 single-target the dominant force, but dual-target GIP/GLP-1 began to fully take over the high-end market.
The reason why Tepolpeptide has achieved the top position is fundamentally its efficacy.
In the head-to-head study SURMOUNT-5 published in the New England Journal of Medicine, teplizumab outperformed semaglutide by achieving an average weight reduction of 20.2% at 72 weeks, while semaglutide achieved 13.7%. This was not a marginal improvement; it was a significant difference that could change doctors' preferences and patients' choices. More importantly, this was not an indirect comparison pieced together across trials but the most compelling head-to-head result available at present. For the weight loss drug market, a difference of a few percentage points in efficacy does not stem from academic debate but rather from the reallocation of prescriptions, payment coverage, and long-term retention.
A more realistic aspect is that Teprotide did not win solely through the weight loss scenario. It reaped the benefits of the simultaneous explosion of the diabetes and obesity markets. Mounjaro continued to expand in the diabetes market, while Zepbound made great progress in the weight loss market. The combination of these two commercial curves resulted in the staggering figure of 36.5 billion US dollars. Eli Lilly did not just secure a single drug; it acquired a metabolic disease commercial machine that spans across indications, payment systems, and channels. For a large pharmaceutical company, this cross-market penetration capability is far more terrifying than a single blockbuster product.
Looking at it from the opposite perspective, Novo Nordisk did not suddenly collapse; rather, it showed signs of fatigue for the first time in this round of competition. In 2025, Novo's total sales still reached 309.064 billion Danish kroner, but the company has clearly given a negative growth guidance for sales and operating profits in 2026. The reasons include intensified competition in the United States, rising price pressure, the expiration of the patent for semaglutide in some international markets, and the fact that the one-time gross profit adjustment factor for the US end will no longer be repeated in 2025. In other words, Novo's problem is not that there is no demand, but that its control over the market is declining.
What's even more fatal is that Eli Lilly is now winning not just in the field of injections.
On April 1st, the oral small molecule GLP-1 drug Foundayo from Eli Lilly was officially approved by the FDA, and it will be available for sale on April 6th. While Novo's oral Wegovy was already launched in January this year, Eli Lilly's product is regarded by the Wall Street as a potential new entry point with greater potential for large-scale sales due to its not being restricted by eating and drinking. That is to say, Eli Lilly is no longer satisfied with suppressing Semaglutide through injection therapy. It is further extending its battle line towards oral administration. The injection stage snatched the crown, and the oral stage will snatch the future. This is the area that makes the market most nervous for Eli Lilly at present.
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Therefore, Teprotumumab's ascension to the position of the world's top drug is far more than just a change of the name on the sales list. It signifies that the power center of the GLP-1 industry has shifted from Novo Nordisk's dominant first stage to Eli Lilly's more aggressive second stage. In the first stage, it was a competition of who could best promote the weight-loss drug as a "supermarket"; in the second stage, it was a competition of who could fully optimize the efficacy, indications, distribution channels, payment methods, and dosage forms. What Teprotumumab won is not just a single endpoint, but the pricing power of the entire metabolic disease era.
If we look at the situation over a longer period of time, this war is far from over. Novo has 7.2mg of high-dose semaglutide in stock, and the STEP UP study has achieved an average weight loss of 20.7%, approaching the range of tirabrutinib; Eli Lilly is continuing to advance its oral small molecule and subsequent multi-target pipeline. At present, the outcome of this battle is more of a phased result in 2025 rather than the final conclusion. But one thing is clear: The GLP-1 is no longer the era defined by semaglutide alone. Tirabrutinib, with a $36.5 billion investment, has told everyone that the real second half has already begun.
