Saxenda vs. Wegovy: Daily vs. Weekly Results From the STEP 8 Trial
Wegovy beat Saxenda clearly in their only head-to-head trial. In STEP 8, people on weekly Wegovy (semaglutide 2.4 mg) lost an average of 15.8% of their body weight over 68 weeks, versus 6.4% on daily Saxenda (liraglutide 3 mg), and half as many quit treatment. As of October 2026, Wegovy also has the broader label, including heart-risk reduction, a liver indication and a pill version.
Key takeaways
- STEP 8 randomized 338 adults without diabetes and found a 9.4 percentage-point weight-loss advantage for Wegovy over Saxenda.
- About 71% of Wegovy users lost at least 10% of their weight, compared with about 26% on Saxenda.
- Stomach side effects were equally common (about 83% to 84%), but 12.6% stopped Saxenda because of side effects versus 3.2% on Wegovy.
- Both are approved for adults and for teens 12 and older with obesity; only Wegovy carries a cardiovascular risk-reduction indication.
- Wegovy costs $349 a month cash through NovoCare as of October 2026; Saxenda coupon prices vary widely by pharmacy.
The basics: two Novo Nordisk drugs, one generation apart
Saxenda is liraglutide, a GLP-1 drug injected once a day. It starts at 0.6 mg and rises by 0.6 mg each week to a 3 mg maintenance dose by week 5 (Saxenda prescribing information).
Wegovy is semaglutide, injected once a week. The pen starts at 0.25 mg and steps up every four weeks, typically reaching 2.4 mg from week 17. The label now also includes a 7.2 mg dose (Wegovy HD) for additional weight reduction in adults, and a daily tablet that climbs from 1.5 mg to 25 mg (Wegovy prescribing information).
So the trade is simple on paper: Saxenda reaches its full dose faster but asks for a shot every day. Wegovy takes about four months to reach its usual maintenance dose but needs one shot a week, or a daily pill.
STEP 8: the head-to-head results
STEP 8 was published in JAMA in 2022. It enrolled adults with obesity, or overweight plus a weight-related condition, who did not have diabetes. Participants were randomized to Wegovy 2.4 mg weekly, Saxenda 3 mg daily, or matching placebo, all alongside diet and activity counseling, for 68 weeks (Rubino et al., JAMA).
| STEP 8 outcome at 68 weeks | Saxenda 3 mg daily | Wegovy 2.4 mg weekly | Placebo |
|---|---|---|---|
| People randomized | 127 | 126 | 85 |
| Average body weight change | −6.4% | −15.8% | −1.9% |
| Lost 10% or more | 25.6% | 70.9% | Not shown |
| Lost 15% or more | 12.0% | 55.6% | Not shown |
| Lost 20% or more | 6.0% | 38.5% | Not shown |
| Any gastrointestinal side effect | 82.7% | 84.1% | 55.3% |
| Stopped because of side effects | 12.6% | 3.2% | 3.5% |
| Stopped for any reason | 27.6% | 13.5% | Not shown |
Source: Rubino DM et al., STEP 8, JAMA 2022;327(2):138-150. Responder percentages are shown for the two active drugs as reported in the Wegovy vs. Saxenda comparison.
The weight difference between the two drugs was 9.4 percentage points (95% CI 6.8 to 12.0; P < .001). Put in everyday terms, a person starting at 250 pounds who matched the averages would lose about 40 pounds on Wegovy and about 16 pounds on Saxenda. Individual results vary widely around those averages.
How much to trust it
STEP 8 is a well-designed randomized trial, but it has limits. The Wegovy-versus-Saxenda comparison was open-label, so participants knew which active drug they were on; each drug was blinded only against its own placebo. It was also modest in size, at 338 people, and excluded people with diabetes. Even so, the gap is large enough that design quirks are unlikely to explain it away.
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Side effects and staying on treatment
The most useful number in STEP 8 may be the dropout rate. Nausea, diarrhea and other stomach effects were nearly universal on both drugs, but people on Saxenda were about four times as likely to quit because of side effects (12.6% vs. 3.2%). Overall, 27.6% stopped Saxenda for any reason, double the 13.5% on Wegovy (STEP 8, JAMA).
The trial does not say exactly why. Saxenda's faster five-week climb to full dose and the daily injection routine are plausible factors, but the study was not built to separate them. What it does show is that, for most people, Wegovy was both more effective and easier to stay on.
Saxenda's label builds in a progress check: adults who have not lost at least 4% of their starting weight after 16 weeks should stop the drug (Saxenda prescribing information). In Saxenda's own 56-week label trial, average weight change was −7.4% versus −3.0% on placebo.
Teens: both are approved, with different rules
Both injections are approved for adolescents 12 and older with obesity, which makes this one of the few weight-loss comparisons that applies to teenagers. STEP 8 itself enrolled adults only, so the head-to-head numbers above do not directly apply to teens.
Saxenda's pediatric trial measured BMI rather than weight. BMI fell 4.29% on Saxenda versus a 0.35% rise on placebo. The label lets teens take up to 8 weeks to reach the full dose, allows 2.4 mg as a maintenance dose if 3 mg is not tolerated, and says to stop if BMI has not dropped at least 1% after 12 weeks on the maintenance dose (Saxenda prescribing information). Saxenda's teen indication also requires body weight above 60 kg. The Wegovy pill is approved for adults only.
What each label covers
| Label feature | Saxenda | Wegovy |
|---|---|---|
| Ingredient | Liraglutide | Semaglutide |
| Dosing | Daily injection, 3 mg maintenance | Weekly injection (2.4 mg usual; up to 7.2 mg in adults) or daily tablet (25 mg maintenance) |
| Chronic weight management | Adults; teens 12+ over 60 kg with obesity | Adults; teens 12+ with obesity (injection only) |
| Cardiovascular risk reduction | No | Yes, adults with established heart disease and obesity or overweight |
| Liver disease (MASH) | No | Yes, accelerated approval for moderate to advanced fibrosis |
| Generic available | Yes (Teva, August 2025) | No |
Sources: Saxenda prescribing information; Wegovy prescribing information (revised 06/2026); Fierce Pharma.
For anyone with existing heart disease, the cardiovascular indication is a real tiebreaker: it is on Wegovy's label and not on Saxenda's. Saxenda's label does describe LEADER, a heart-safety trial of liraglutide 1.8 mg (Victoza) in adults with type 2 diabetes that found no increased risk of major cardiovascular events, but it does not list heart-risk reduction as a Saxenda use (Saxenda prescribing information).
Cost and coverage in October 2026
Novo Nordisk sells Wegovy pens directly for $349 a month at every standard dose, with new patients paying $199 for each of their first two months on the lowest doses through December 31, 2026. The 7.2 mg dose is $399, and the Wegovy pill ranges from $149 to $299 depending on dose (NovoCare).
Saxenda's cash price depends heavily on the pharmacy. GoodRx's Saxenda page listed five-pen coupon prices from about $372 at some pharmacies to about $1,241 at others in October 2026 (GoodRx). Generic liraglutide launched at a wholesale price of $1,165 a month, versus $1,350 for brand Saxenda (Fierce Pharma).
On Medicare, the GLP-1 Bridge running from July 2026 through December 2027 covers Wegovy (pill and injection) for weight loss at a $50 monthly copay for eligible Part D enrollees. Eligibility requires Part D enrollment plus a BMI of 35 or higher, or 27 or higher with a qualifying condition, and prior authorization. Saxenda is not on the list (NPR via WLRN).
Who might still choose Saxenda
- People whose plan covers liraglutide but not Wegovy. A covered drug at a low copay can make sense even with smaller expected results.
- People already doing well on it. If Saxenda is working and tolerated, switching is a judgment call to make with your prescriber.
- People who want a daily routine. Some prefer a daily habit to a weekly one, though the Wegovy pill now offers daily dosing with semaglutide.
The verdict
For most people choosing between the two in October 2026, Wegovy is the stronger option. In STEP 8 it produced about two and a half times the weight loss, far fewer people quit, it costs a predictable $349 a month cash, and its label adds heart and liver indications that Saxenda lacks. Saxenda remains reasonable mainly when insurance covers it and not Wegovy, or when someone is already succeeding on it. Ask your prescriber which fits your health history and coverage.
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Frequently asked questions
Which works better, Saxenda or Wegovy?
In the STEP 8 head-to-head trial, Wegovy 2.4 mg weekly produced 15.8% average weight loss at 68 weeks versus 6.4% for Saxenda 3 mg daily, a 9.4 percentage-point difference.
Does Wegovy cause more side effects than Saxenda?
Stomach side effects were about equally common in STEP 8 (84.1% on Wegovy, 82.7% on Saxenda), but 12.6% stopped Saxenda because of side effects compared with 3.2% on Wegovy.
Are Saxenda and Wegovy approved for teenagers?
Yes. Both injections are approved for adolescents 12 and older with obesity; Saxenda's label also requires body weight over 60 kg. The Wegovy pill is approved for adults only.
How much does Wegovy cost compared with Saxenda?
As of October 2026, NovoCare lists Wegovy pens at $349 a month cash, with $199 for the first two months for new patients. GoodRx listed Saxenda five-pen coupon prices from about $372 to $1,241 depending on the pharmacy.
Sources
- Rubino DM et al. Effect of weekly subcutaneous semaglutide vs daily liraglutide on body weight (STEP 8). JAMA 2022;327(2):138-150
- Saxenda Prescribing Information, Novo Nordisk
- Wegovy Prescribing Information, Novo Nordisk, revised 06/2026
- Price your Wegovy, NovoCare
- Saxenda (liraglutide) prices, GoodRx
- With Saxenda generic, Teva launches first copycat GLP-1 for obesity, Fierce Pharma, August 2025
- A new Medicare option for weight-loss drugs is coming, NPR via WLRN, May 2026
Medical disclaimer: This article is general information, not medical advice, and does not replace a licensed clinician who knows your history. Approvals, labels, coverage and prices change; check the linked sources and talk with your prescriber or pharmacist before making decisions about any medication.