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37.5% of class 3 obesity entrants exited clinical obesity entirely Waist circumference reduction: -24.1 cm at 12 mg vs -3.6 cm placebo 104 wk extension (n=532, BMI 35 baseline 121.7 kg, BMI 42.8): 12 mg to MTD: -30.3% (-85.0 lbs) 9 mg to MTD: -29.5% (-80.7 lbs) 4 mg to MTD: -27.9% (-73.3 lbs) Placebo to MTD: -19.2% (-49.9 lbs) Cardiometabolic improvements vs placebo: waist circumference, non-HDL cholesterol, triglycerides, systolic BP, hsCRP 4 mg dose: AE-driven discontinuation rate lower than placebo Strategic takeaways: First triple agonist past phase 3, ahead of every competing program TWL distribution closes gap with bariatric surgery (Roux-en-Y ~30%, sleeve ~25%) Pressure on bariatric procedure volumes, PBM utilization management regimes, ICER cost-effectiveness models LLY widens lead over NVO further
