Novo Nordisk (NYSE: NVO) has released new real-world evidence showing that escalating to semaglutide injection 2 mg is associated with meaningfully better cardiovascular outcomes than switching to tirzepatide.
Adults with type 2 diabetes who increased their dose to semaglutide 2 mg showed a statistically significant 6% lower risk of major adverse cardiovascular events compared to those who switched to tirzepatide up to 15 mg.
The findings were presented at the European Association for the Study of Diabetes Annual Meeting 2026 in Milan, Italy, under the name COMPETE SWITCH CV.
The retrospective real-world analysis drew on claims data covering 636,525 adults living with type 2 diabetes, making it one of the largest such comparisons of GLP-1 receptor agonist intensification strategies.
Major adverse cardiovascular events tracked in the study included all-cause death, myocardial infarction, and stroke, with results reflecting an adjusted hazard ratio of 1.06 with a 95% confidence interval of 1.04 to 1.08.
Michael Radin, MD, executive medical director at Novo, said: “These data may help inform healthcare professionals facing a critical challenge: whether to increase the dosage or switch to another therapy for an adult with type 2 diabetes who is already treated with semaglutide.”
Radin added: “These real-world findings can help provide insights into how intensification strategies may affect cardiovascular outcomes as an important factor in patient care.”
Among the full study cohort at 365 days, 29.2% of patients had escalated to semaglutide 2 mg while just 3.6% had switched to tirzepatide, with the remainder continuing on semaglutide 1 mg.
By the 720-day follow-up mark, treatment intensification had continued, with 36.9% of patients escalating to semaglutide 2 mg and 5.7% switching to tirzepatide, reflecting ongoing clinical pressure to adjust therapy over time.
Kathryn S. Tierney, MSN, APRN, FNP-BC, FAANP, of Middlesex Health MultiSpecialty Group in Middletown, CT, said: “These real-world findings suggest that escalating to semaglutide 2 mg may be a meaningful option for appropriate patients, as intensification of treatment was associated with a lower risk of major adverse cardiovascular events than those who switched therapies.”
The cardiovascular component of COMPETE SWITCH included 185,705 adults who escalated to semaglutide 2 mg and 23,104 adults who switched to tirzepatide, all followed from the point of dose change or end of the study period.
Approximately 31% of patients who switched to tirzepatide reached a dose of 10 mg or higher during the follow-up period, reflecting meaningful titration across the tirzepatide dosing regimen.
A subset analysis evaluating patients with more than one HbA1c or weight measurement at baseline produced consistent results, with an adjusted hazard ratio of 1.07 and a 95% confidence interval of 1.01 to 1.13.
The study used Komodo Health’s Healthcare Map with linked laboratory results, drawing on US healthcare claims data spanning January 2018 through September 2025 to assess real-world treatment patterns.
Researchers noted that while the findings provide valuable insight into how treatments perform outside of controlled clinical trials, residual unmeasured confounding remains a limitation and causal relationships cannot be definitively established.
Novo employs over 67,000 people globally and has maintained a presence in the United States for 40 years, with its US headquarters in New Jersey and approximately 10,000 American employees.
