Retatrutide Beats Ozempic 2 mg in TRANSCEND-T2D-2 (October 28, 2026)
TRANSCEND-T2D-2 results, Oct 28, 2026: retatrutide cut A1C 2.2 points vs 1.8 on Ozempic 2 mg and weight 20.9% vs 9.4%. The numbers, the caveats, what's next.
Event date Last verified Primary source Eli Lilly and Company (PR Newswire)
The TRANSCEND-T2D-2 results, which Eli Lilly released on October 28, 2026, are the first time retatrutide has gone head to head with another drug, and it beat Ozempic 2 mg on both blood sugar and weight. After 80 weeks, A1C fell 2.2 points on retatrutide 9 mg and 12 mg against 1.8 on Ozempic, and weight fell 20.9% on 12 mg against 9.4%. The primary source is Lilly's October 28 release, and every number in it uses the efficacy estimand.
Key takeaways
- TRANSCEND-T2D-2 is the first trial to put retatrutide head to head with another incretin drug, and it met its primary and all key secondary endpoints, according to Lilly.
- Both retatrutide doses lowered A1C by 2.2 points against 1.8 on Ozempic 2 mg; the 9 mg advantage on A1C was nominal only.
- Weight fell 19.5% on 9 mg and 20.9% on 12 mg against 9.4% on Ozempic, from an average of 102.4 kg (225.8 lb).
- Every figure is Lilly's efficacy estimand. There's no journal paper yet and no treatment-regimen result.
This page is the dated record of the announcement. The trial itself, arm by arm, lives on the TRANSCEND-T2D-2 page.
What Lilly announced on October 28
TRANSCEND-T2D-2 randomized 1,298 adults with type 2 diabetes that metformin, with or without an SGLT2 inhibitor, wasn't controlling. Their A1C was 7.0% to 10.5% at entry. They were split 2:2:1 between retatrutide 9 mg, retatrutide 12 mg and Ozempic 2 mg, all once a week, for 80 weeks. It was open label, so everyone knew which drug they were taking.
The primary goal was to show that 12 mg lowers A1C at least as well as Ozempic 2 mg. Lilly says retatrutide "met the primary and all key secondary endpoints," and calls it "the first Phase 3 trial comparing retatrutide with another incretin medicine." It is also the sixth Phase 3 trial with positive results.
The TRANSCEND-T2D-2 results by dose
From a starting A1C of 8.3%, both retatrutide doses brought it down 2.2 points, against 1.8 on Ozempic. Weight fell 19.5% (20.1 kg) on 9 mg and 20.9% (21.5 kg) on 12 mg, against 9.4% (9.5 kg) on Ozempic, from an average of 102.4 kg (225.8 lb).
Retatrutide vs Ozempic in TRANSCEND-T2D-2
1,298 adults with type 2 diabetes on metformin, 80 weeks, open-label, efficacy estimand
The statistics come with one asterisk. The 12 mg comparisons were controlled for false positives across the whole set of tests. The 9 mg advantage over Ozempic on A1C, and on systolic blood pressure, was nominal only, which is a weaker kind of finding. Lilly also says non-HDL cholesterol, triglycerides and blood pressure improved more than on Ozempic, but it released no numbers for them.
Side effects, as Lilly reported them:
| Side effect or outcome | Retatrutide 9 mg | Retatrutide 12 mg | Ozempic 2 mg |
|---|---|---|---|
| Diarrhea | 28.3% | 32.7% | 26.4% |
| Nausea | 21.2% | 23.8% | 21.3% |
| Constipation | 14.2% | 13.1% | 19.8% |
| Vomiting | 10.2% | 15.0% | 13.2% |
| Burning or oversensitive skin (dysesthesia) | 4.8% | 6.5% | 2.7% |
| Stopped treatment because of side effects | 4.8% | 7.9% | 2.7% |
What the head-to-head result means
On 12 mg, the average person lost about a fifth of their body weight, against about a tenth on the top dose of Ozempic. That's the bigger gap. On blood sugar the difference is 0.4 points of A1C, real but modest.
Two things limit how far you can push it. The trial was open label, and the efficacy estimand counts people as if they all stayed on their drug for 80 weeks without adding extra diabetes medicine for more than 14 days. Lilly hasn't released the everyone-randomized (treatment-regimen) numbers, which are usually smaller. And while nausea was about as common as on Ozempic, more people quit retatrutide because of side effects.
Our read: if you're on Ozempic for type 2 diabetes, this is the first direct evidence that retatrutide does more for weight, and only a bit more for A1C. The retatrutide vs Ozempic page puts it next to Ozempic's own trials, and retatrutide for type 2 diabetes covers the rest of the diabetes evidence.
What's still missing
There's no journal paper, so no treatment-regimen figures, no lipid or blood pressure values and no serious adverse event rates. ClinicalTrials.gov still lists enrollment as 1,250 estimated, while Lilly says 1,298 were randomized. About 650 people are continuing on retatrutide for 24 more weeks in an extension, and the registry expects the whole study to finish in February 2027 (estimated).
What comes next after TRANSCEND-T2D-2
Lilly names TRIUMPH-5, retatrutide against tirzepatide in adults with obesity, as ongoing. ClinicalTrials.gov expects it to finish collecting its main results in November 2026 (estimated); the TRIUMPH-5 page tracks it. Neither the October 28 release nor Lilly's October 29 quarterly filing with the SEC gives a filing date.
Lilly last said, on September 29, 2026, that it plans to submit retatrutide to the FDA in the first quarter of 2027 as a Biologics License Application (BLA). On October 2, 2026, the FDA decided that retatrutide is a drug, not a biological product, so an application would need to be filed under section 505 of the Federal Food, Drug, and Cosmetic Act. Lilly's appeal on that question is pending in the Seventh Circuit, and we found no ruling as of October 31, 2026.
Until then no approved version exists, and anything listed as retatrutide for sale online isn't Lilly's product. The release says it plainly: "Anyone purporting to sell retatrutide to consumers is breaking the law."
Frequently asked questions
Did retatrutide beat Ozempic in TRANSCEND-T2D-2?
Yes, on both main measures. After 80 weeks, A1C fell 2.2 points on retatrutide 9 mg and 12 mg against 1.8 on Ozempic 2 mg, and weight fell 19.5% and 20.9% against 9.4%. All of these are Lilly's efficacy estimand figures.
Which Ozempic dose was used?
Ozempic 2 mg once weekly, the highest approved dose. Retatrutide started at 2 mg and went up every 4 weeks to its target of 9 mg or 12 mg.
Were side effects worse on retatrutide than on Ozempic?
Rates of nausea were close (21.2% and 23.8% against 21.3%), and constipation was lower on retatrutide. More people stopped retatrutide because of side effects, though: 4.8% on 9 mg and 7.9% on 12 mg against 2.7% on Ozempic.
Is TRANSCEND-T2D-2 published in a journal?
Not as of October 31, 2026. Lilly says detailed results will come at a future medical meeting and in a peer-reviewed journal, without giving dates.
Sources
- Lilly's retatrutide delivered greater A1C reduction and more than double the weight loss of Ozempic's highest approved dose in head-to-head trial. Eli Lilly and Company (PR Newswire), 2026. prnewswire.com
- Effect of Retatrutide Compared With Semaglutide in Adult Participants With Type 2 Diabetes (TRANSCEND-T2D-2), NCT06260722. ClinicalTrials.gov, U.S. National Library of Medicine, 2026. clinicaltrials.gov
- Lilly reports third-quarter 2026 financial results (Form 8-K, exhibit 99.1). Eli Lilly and Company (U.S. Securities and Exchange Commission), 2026. sec.gov
- A Study of Retatrutide (LY3437943) Compared to Tirzepatide (LY3298176) in Adults Who Have Obesity (TRIUMPH-5), NCT06662383. ClinicalTrials.gov, U.S. National Library of Medicine, 2026. clinicaltrials.gov
- FDA decision on remand on whether retatrutide is a biological product, October 2, 2026 (filed in the Seventh Circuit as Doc. 46-2). U.S. Food and Drug Administration (CourtListener RECAP archive), 2026. storage.courtlistener.com
Dr. Juan Pablo Frías, MD
Physician-Scientist & Clinical Trialist • Endocrinology, Diabetes & Metabolism
Dr. Frías earned his M.D. from Vanderbilt University School of Medicine and completed his endocrinology fellowship at UC San Diego. A principal investigator on landmark incretin trials (including retatrutide, tirzepatide and semaglutide), he reviews all guides on Retatrutide360 for clinical accuracy, dosing safety and evidence fidelity.
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