Lilly’s retatrutide cut A1C by 2.2 points and weight by 20.9% against Ozempic’s 1.8 and 9.4% in the TRANSCEND-T2D-2 trial reported October 28, 2026.
Last updated: October 29, 2026
Eli Lilly’s retatrutide lowered A1C by 2.2 percentage points and body weight by up to 20.9 percent over 80 weeks in TRANSCEND-T2D-2, beating Ozempic 2 mg on both measures in the first Phase 3 head to head between incretin medicines.
This briefing covers Wednesday, October 28, 2026: the retatrutide head to head readout, Boston Scientific’s third guidance cut of the year, Biogen’s third quarter, and the diagnostics deals the week opened with.
What did retatrutide show against Ozempic in TRANSCEND-T2D-2?
Both retatrutide doses lowered A1C by 2.2 percentage points at 80 weeks versus 1.8 points for Ozempic 2 mg, and cut body weight by 19.5 to 20.9 percent versus 9.4 percent, in 1,298 adults with type 2 diabetes inadequately controlled on metformin.
Eli Lilly announced the topline on Wednesday morning. TRANSCEND-T2D-2 is the first Phase 3 trial to compare retatrutide, Lilly’s once weekly GIP, GLP-1 and glucagon receptor triple agonist, with another incretin medicine, and Lilly chose the highest approved dose of Novo Nordisk’s semaglutide for type 2 diabetes as the comparator. The headline from the company’s own release: more than double the weight loss of Ozempic 2 mg.
| Measure at 80 weeks | Retatrutide 9 mg | Retatrutide 12 mg | Ozempic 2 mg |
|---|---|---|---|
| A1C change (percentage points) | −2.2 | −2.2 | −1.8 |
| Body weight change | −19.5% (−20.1 kg) | −20.9% (−21.5 kg) | −9.4% (−9.5 kg) |
| Discontinued for adverse events | 4.8% | 7.9% | 2.7% |
| Diarrhea / nausea | 28.3% / 21.2% | 32.7% / 23.8% | 26.4% / 21.3% |
All figures are from Lilly’s October 28 release. The 12 mg dose beat Ozempic on A1C with statistical significance under the trial’s controlled testing plan (p<0.001). The 9 mg comparison on A1C was a prespecified secondary with nominal significance, a distinction that matters for how the lower dose can be described on a label. Weight loss superiority was significant for both doses. Lilly said the most common adverse events were gastrointestinal and mostly mild to moderate, and that detailed results go to a future medical meeting and a peer reviewed journal.
How was TRANSCEND-T2D-2 designed, and what are the caveats?
The trial randomized 1,298 adults 2:2:1 to retatrutide 9 mg, retatrutide 12 mg, or Ozempic 2 mg, all once weekly for 80 weeks. It was open label, so patients and physicians knew the assignment, which matters most for behavior driven endpoints like weight.
Participants had type 2 diabetes inadequately controlled on metformin, with or without an SGLT2 inhibitor, with baseline A1C between 7.0 and 10.5 percent. The enrolled population averaged an A1C of 8.3 percent, weight of 102.4 kg and a BMI of 36.8. Retatrutide started at 2 mg and escalated every four weeks to target. The stated primary objective was noninferiority of the 12 mg dose on A1C, which the superiority result exceeded. About 650 participants continue on retatrutide in a 24 week extension. The open label design and the efficacy estimand (which measures the effect while on treatment) are the two caveats worth carrying; neither is unusual for this class, and the A1C result is an objective lab measure.
What does the head to head result mean for the GLP-1 market?
Retatrutide now has superiority data against the incumbent standard in type 2 diabetes, and Lilly is already running TRIUMPH-5, a head to head against its own tirzepatide in obesity. Comparative wins, not placebo wins, are becoming the price of entry at the top of the incretin market.
Lilly’s release did not restate filing timing; the company pointed earlier this year to a first submission window in the first quarter of 2027. The discontinuation gap (7.9 percent at 12 mg versus 2.7 percent on Ozempic) gives Novo a tolerability argument, and the dysesthesia signal seen across the retatrutide program appeared here too (4.8 to 6.5 percent versus 2.7 percent). Leerink’s David Risinger wrote that the result strengthens retatrutide’s long term differentiation and modeled $15 billion in 2032 sales against a consensus near $10 billion, noting semaglutide’s 2032 US patent expiry, per BioPharma Dive. On the day, Lilly closed at $1,288.30, up 0.5 percent, and Novo Nordisk’s ADRs closed at $38.29, down 1.0 percent; the readout was the session’s defining event for both, though neither move was large.
Why did Boston Scientific cut its 2026 guidance a third time?
Boston Scientific now expects full year 2026 sales growth of approximately 4.25 percent reported and 3.75 percent organic, with adjusted EPS of $3.16 to $3.18, after guiding to 10.5 to 11.5 percent growth in February. The August cyberattack did the latest damage, but Watchman and electrophysiology softness was already doing the rest.
Third quarter net sales were $5.138 billion, up 1.5 percent on a reported, operational and organic basis. GAAP EPS was $0.40 versus $0.51 a year ago, and adjusted EPS was $0.73 versus $0.75. For the fourth quarter the company guided to a sales decline of approximately 1 to 3 percent versus the prior year, with adjusted EPS of $0.77 to $0.79. The stock closed at $42.43, down 5.8 percent.
| 2026 guidance vintage | Net sales growth | Adjusted EPS |
|---|---|---|
| February (original) | 10.5% to 11.5% | $3.43 to $3.49 |
| July 29 | 5.5% to 6.5% | $3.28 to $3.32 |
| October 28 (current) | ~4.25% reported / ~3.75% organic | $3.16 to $3.18 |
Prior guidance figures per MedTech Dive’s reporting of the earlier releases. On the call, per MedTech Dive, chief executive Mike Mahoney said Watchman sales fell 6 percent and electrophysiology fell 5 percent in the quarter, pointing to changes in patient identification and referral patterns for Watchman and competitive pressure in pulsed field ablation. He also said the company will be challenged to grow sales and adjusted EPS next year, and that the $14.5 billion Penumbra acquisition now closes in early 2027 rather than this year because the regulatory process has taken time.
How much did the August cyberattack cost Boston Scientific?
The company told investors the incident cost roughly $150 million of third quarter revenue, per MedTech Dive; the press release itself quantified nothing. The attack was identified on August 25 and disclosed August 26, and temporarily shut down ordering, manufacturing and shipping.
The September 8 8-K had already warned the incident was likely to have a material impact on third quarter and full year results and that the July guidance ranges were unlikely to be met. Mahoney’s release quote called 2026 “a challenging year” and credited teams with restoring operations. The unanswered question for the fourth quarter guide, which implies shrinking sales, is how much is lingering cyber disruption and how much is the Watchman and electrophysiology slowdown that predates the attack.
How did Biogen return to growth in the third quarter of 2026?
Biogen reported revenue of $2.8 billion, up 11 percent, its growth portfolio up 49 percent, and raised the bottom of its EPS guidance. The market’s answer: the stock fell 3.4 percent to $244.05.
| Q3 2026 line | Revenue | Change |
|---|---|---|
| Total revenue | $2,804.1M | +11% |
| Spinraza | $460.6M | +23% |
| Skyclarys | $178.2M | +34% |
| Syfovre (Apellis) | $191.3M | +27% |
| Zurzuvae | $84.4M | +53% |
| Alzheimer’s collaboration revenue | $68.4M | +60% |
| MS franchise | $919.3M | −13% |
The quarter was the first with a full Apellis contribution, and the growth portfolio now makes up 63 percent of core pharmaceutical revenue. GAAP EPS was a loss of $0.14 on transaction related charges; non GAAP EPS of $2.62 included $284 million of acquired IPR&D, mainly from the RayThera deal. Eisai recorded $202 million of global in market Leqembi sales, up 67 percent, with $107 million in the US. Biogen raised the lower end of reported non GAAP EPS guidance to $12.20 to $13.00 and moved the underlying range to $15.95 to $16.75. Chief executive Christopher Viehbacher said the results show “Biogen has returned to growth.” The nearest catalyst is litifilimab’s TOPAZ-1 and TOPAZ-2 Phase 3 lupus toplines, which the release placed in the first half of December 2026, with the CLE study and felzartamab in antibody mediated rejection in the first half of 2027 and zorevunersen in Dravet syndrome in the third quarter of 2027.
What happened in diagnostics: Abbott’s Oncodetect and RadNet’s Onrad deal?
Abbott launched a whole genome sequencing version of its Oncodetect residual disease test that tracks up to 5,000 patient specific mutations, and RadNet agreed to buy teleradiology provider Onrad for $350 million upfront. Both landed Monday and set the week’s tone in diagnostics.
The new Oncodetect, built on technology from the Broad Institute and acquired with the $21 billion Exact Sciences purchase that closed in March, tracks as many as 5,000 patient specific mutations versus up to 200 in the prior test and detects circulating tumor DNA below one part per million, versus 15 to 50 parts per million for the whole exome version, per Abbott via MedTech Dive. In the Beta-CORRECT study presented at ESMO, Abbott cited a 30 percentage point sensitivity gain in colorectal cancer. Abbott’s Rick Baehner put the US addressable population above 3 million patients with roughly 10 percent market penetration today.
RadNet’s Onrad deal adds more than 270 US customers and a network of more than 130 radiologists, with 5 million RadNet shares on top of the $350 million upfront and up to $210 million more tied to a 2027 earnings target, per MedTech Dive. RadNet will stand up a new Radiology Professional Services segment around it. Chief executive Howard Berger said hospital partners see radiologist coverage as a choke point, and that inbound calls were not necessarily about AI tools but about solving that staffing problem now. Stryker also closed its purchase of Swiss rotator cuff repair company ZuriMED on Monday; terms were not disclosed.
Which stocks moved on Wednesday’s news?
Settled closes, moves versus Tuesday, our arithmetic throughout.
| Ticker | Close | Move | Context |
|---|---|---|---|
| BSX | $42.43 | −5.8% | Third 2026 guidance cut; Q4 sales guided to decline |
| BIIB | $244.05 | −3.4% | Returned to growth, raised the guidance floor, market paid nothing |
| NVO / LLY | $38.29 / $1,288.30 | −1.0% / +0.5% | The retatrutide head to head session |
| LQDA | $45.72 | +0.6% | Sixth straight up session, +33.1% since October 16; no disclosure found (searches tonight surfaced only October 2025 R&D day items) |
| IOVA | $14.81 | +1.6% | Data webcast notice landed after the close; Thursday is the first reaction session |
Context: XBI closed at $157.51, up 1.7 percent; SPY at $772.31, up 0.3 percent.
What should investors and operators watch next?
Merck reports third quarter results Thursday before the open, the test of whether its slide stops at its own quarter. Iovance hosts its lifileucel lung cancer data webcast Thursday at 8:30 am ET; Wednesday’s release called the IOV-LUN-202 registrational cohort data positive but included no figures, so the numbers arrive with the webcast. Friday is the FDA’s Expedited IND Pilot application deadline. After the close Wednesday, HUTCHMED’s sovleplenib, an oral Syk inhibitor, received US orphan drug designation for primary immune thrombocytopenia; its China filings in ITP and warm autoimmune hemolytic anemia are already under review. Zai Lab’s offering closing release, expected on or about October 27, had still not appeared as of Wednesday night, with only stale 2021 and 2024 closing releases surfacing in searches.
Frequently asked questions
What is retatrutide and how does it work?
Retatrutide is Eli Lilly’s investigational once weekly injection that activates three receptors: GIP, GLP-1 and glucagon. The glucagon component adds energy expenditure effects on top of the appetite and glycemic effects of dual agonists like tirzepatide.
Did retatrutide beat Ozempic in the head to head trial?
Yes. In TRANSCEND-T2D-2, retatrutide 12 mg lowered A1C by 2.2 percentage points versus 1.8 for Ozempic 2 mg at 80 weeks, with statistical significance, and both retatrutide doses more than doubled Ozempic’s weight loss.
How much weight did patients lose on retatrutide versus Ozempic?
At 80 weeks, patients lost 20.9 percent of body weight (21.5 kg) on retatrutide 12 mg and 19.5 percent (20.1 kg) on 9 mg, versus 9.4 percent (9.5 kg) on Ozempic 2 mg.
Is retatrutide approved by the FDA?
No. Retatrutide is investigational and not approved anywhere. Lilly has previously pointed to a first submission window in the first quarter of 2027; Wednesday’s release did not restate timing.
What are retatrutide’s side effects in TRANSCEND-T2D-2?
Mostly gastrointestinal: diarrhea in 28.3 to 32.7 percent and nausea in 21.2 to 23.8 percent of retatrutide patients. Discontinuation for adverse events was 4.8 percent at 9 mg and 7.9 percent at 12 mg, versus 2.7 percent on Ozempic. Dysesthesia occurred in 4.8 to 6.5 percent versus 2.7 percent.
Why did Boston Scientific stock fall on October 28, 2026?
The company cut its full year 2026 guidance for the third time this year and guided fourth quarter sales to a 1 to 3 percent decline. Shares closed down 5.8 percent at $42.43.
What is Boston Scientific’s new 2026 guidance?
Approximately 4.25 percent reported and 3.75 percent organic net sales growth, with adjusted EPS of $3.16 to $3.18. February’s original guidance was 10.5 to 11.5 percent growth and $3.43 to $3.49.
How much did the Boston Scientific cyberattack cost?
Roughly $150 million of third quarter revenue, according to the company’s remarks reported by MedTech Dive. The incident was identified August 25, 2026 and disrupted ordering, manufacturing and shipping. The press release did not quantify the impact.
When will the Boston Scientific Penumbra acquisition close?
Early 2027, per the company on its third quarter call. The $14.5 billion deal had been expected to close in 2026; Mahoney said the regulatory process has taken time.
How much revenue did Biogen report in the third quarter of 2026?
$2.804 billion, up 11 percent reported and 10 percent at constant currency, with the growth portfolio up 49 percent to $1.26 billion in the first full quarter including Apellis products.
What is litifilimab and when does it read out?
Litifilimab is Biogen’s BDCA2 directed antibody for lupus. Topline data from the TOPAZ-1 and TOPAZ-2 Phase 3 studies in systemic lupus erythematosus are expected in the first half of December 2026.
What is Abbott’s new Oncodetect test?
A whole genome sequencing version of its molecular residual disease test that tracks up to 5,000 patient specific mutations and detects circulating tumor DNA below one part per million, launched October 26 per Abbott.
What is RadNet paying for Onrad?
$350 million upfront plus 5 million RadNet shares, with up to $210 million more tied to a 2027 earnings target, per MedTech Dive. Onrad brings more than 270 US customers and over 130 radiologists.
What data will Iovance present on October 29?
Results from the registrational Phase 2 cohorts of IOV-LUN-202, testing lifileucel TIL therapy in previously treated nonsquamous metastatic non small cell lung cancer. The company called the data positive but released no figures ahead of the 8:30 am ET webcast.
Sources
Primary sources: Eli Lilly press release, October 28, 2026 (investor.lilly.com): TRANSCEND-T2D-2 topline results. Boston Scientific press release, October 28, 2026 (news.bostonscientific.com): third quarter 2026 results and guidance. Boston Scientific Form 8-K, September 8, 2026 (sec.gov): cybersecurity incident disclosure. Biogen press release via Form 8-K exhibit 99.1, October 28, 2026 (sec.gov): third quarter 2026 results. Iovance Biotherapeutics press release, October 28, 2026 (GlobeNewswire): webcast announcement. HUTCHMED press release, October 28, 2026 (GlobeNewswire): sovleplenib orphan drug designation.
Trade coverage: MedTech Dive, October 27 to 28, 2026 (Boston Scientific guidance history and call detail; Abbott Oncodetect launch; RadNet and Onrad; Stryker and ZuriMED). BioPharma Dive, October 28, 2026 (retatrutide coverage and Leerink commentary). BioSpace and Endpoints News front pages, October 28, 2026 (Leerink M&A note; HHS peptides report; financing items). Associated Press, October 15, 2026 (peptides interim access policy background). Market data: exchange settled closes via Robinhood; all percentage moves are our arithmetic.
