How large is the efficacy gap compared with Ozempic?

  • In TRANSCEND-T2D-2, a phase III head-to-head trial in a harder-to-treat population with type 2 diabetes, the Retatrutide 9 mg and 12 mg groups lost 19.5% and 20.9% of their weight, respectively, versus 9.4% in the Ozempic 2 mg group.
  • Glycated hemoglobin fell by 2.2 percentage points in both Retatrutide dose groups and by 1.8 percentage points in the Ozempic group. Glycated hemoglobin is a measure of blood glucose control.

How do the statistical results and tolerability differ between the two doses?

  • The 12 mg dose achieved superiority on both weight loss and glycated hemoglobin endpoints after controlling for multiple comparisons; the 9 mg dose achieved superiority on weight loss and first demonstrated non-inferiority on glycated hemoglobin, with superiority achieving only nominal statistical significance.
  • Citi believes tolerability was consistent with that of incretin-based drugs, but adverse events increased with dose. Dose selection therefore needs to consider both efficacy and tolerability.

Why is the comparison with tirzepatide attracting more attention?

  • Citi believes the results reinforce Retatrutide’s differentiated efficacy in weight loss and blood glucose control and strengthen its position as a long-term growth engine for Eli Lilly’s cardiometabolic business. Bloomberg’s compiled market consensus for sales in 2032 is 11.2 billion dollars.
  • The report expects a US FDA submission for Retatrutide in the first quarter of 2027; Citi believes the head-to-head trial TRIUMPH-5 against Eli Lilly’s own tirzepatide is more important, with data expected in the fourth quarter of 2026.
  • Citi maintained its buy rating and 1600 dollar price target on Eli Lilly. Its valuation uses a discounted cash flow model with explicit forecasts through 2035, assuming a weighted average cost of capital of 6% and a terminal growth rate of 2.6%.