Zepbound Beats Wegovy in Battle of Weight-Loss Drug Titans

ZEPBOUND BEATS WEGOVY IN BATTLE OF WEIGHT-LOSS DRUG TITANS

Head-to-head trial finds both drugs are effective, but Zepbound is superior

Texas Telemedicine Doctor
June 2025

Three GLP-1 drugs, Zepbound (tirzepatide), Wegovy (semaglutide), and Saxenda (liraglutide), are currently approved for weight loss. Zepbound and Wegovy have demonstrated superior weight loss (16% to 22%) compared to Saxenda (8%), making them two of the most discussed medications in decades. Now, they have been compared head-to-head in a trial, where 751 overweight, nondiabetic adults were randomized to Zepbound (target dose 10 mg or 15 mg/week) or Wegovy (target dose of 1.7 mg or 2.4 mg/week). The primary outcome, percent change in weight from baseline to week 72, was -20.2% with Zepbound and -13.7% with Wegovy. Key secondary outcomes, including average weight loss (50 lbs vs 33 lbs) and the proportion of participants achieving a weight reduction of 20% or more (48% vs 27%), also favored Zepbound. Side effects, including nausea (44% vs 44%), constipation (28% vs 29%), diarrhea (24% vs 23%), and vomiting (15% vs 21%), were similar between groups and mainly occurred during the therapy titration phase. Drug discontinuation due to adverse events was slightly higher in the Wegovy group (6.1% vs 8%).

These results corroborate findings from placebo-controlled studies, which showed that both drugs are highly effective, but Zepbound is superior. Patients sometimes ask me if one of the two has fewer side effects, and I can now confidently say they are similar in that regard. For those who are unaware, current cash pricing for both drugs is detailed below.

Zepbound cash pay: Eli Lilly offers Zepbound in two forms: pens and vials. The pens are pressed against the skin, and the medication is injected when a button is pushed. The vials require the patient to draw the medication into a syringe and inject it themselves. Pens cost $650/month with the Zepbound savings card (see Zepbound coverage and cost). The vials are available from LillyDirect at the following prices:

2.5 mg: $299 per month
5 mg: $399 per month
7.5 mg: $449 per month ^✝
10 mg: $449 per month ^✝
12.5 mg: $449 per month ^✝
15 mg: $449 per month ^✝

^✝For the 7.5 mg, 10 mg, 12.5 mg, and 15 mg vials, LillyDirect requires that refills be purchased within 45 days of the delivery date of the previous Zepbound vial prescription to maintain the $449 price. If the refill purchase is completed more than 45 days after delivery of the previous Zepbound vial prescription, pricing will be as follows: $599 for 7.5 mg, $699 for 10 mg, $849 for 12.5 mg, and $1049 for 15 mg.

Wegovy cash pay: Novo Nordisk now offers all doses of Wegovy for $349/month through their online mail-order pharmacy, NovoCare Pharmacy. Additionally, between November 17, 2025, and March 31, 2026, new Wegovy patients can receive the first two doses (0.25 and 0.5 mg) for $199 per month. See Wegovy savings for more.