COPENHAGEN — Novo Nordisk raised its full-year sales and profit outlook Tuesday and beat second-quarter earnings forecasts, but its U.S.-listed shares fell 6 percent as investors focused on a narrow sales miss for its new Wegovy pill and a trial setback for the obesity drug meant to keep the Danish company competitive with Eli Lilly.

The market's reaction underscored how narrow Novo's path back to the top of the weight-loss market has become. After ceding U.S. injectable ground to Lilly, Novo has leaned on the oral Wegovy launched in January and a next-generation candidate called CagriSema. Tuesday's numbers gave investors reason to doubt both.

The quarter

Novo reported adjusted operating profit of 33.4 billion Danish crowns in the second quarter, up 11 percent from a year earlier, against a mean forecast of 28.74 billion in a company-compiled poll. It now expects full-year sales and operating profit growth in a range of zero to minus 6 percent at constant exchange rates, versus a previous range of minus 12 percent to minus 4 percent.

The oral Wegovy figure, the most closely watched line in the release, came in at 3.22 billion crowns, or $497 million, just below the 3.3 billion analysts had expected. Novo has recorded nearly 5 million prescriptions for the pill since its January launch.

"The only surprise I see is that oral Wegovy was just in line with expectations," said Markus Manns, portfolio manager at Union Investment. BMO Capital Markets analyst Evan Seigerman said the quarter's underlying commercial performance was "overshadowed by questions around the modest miss for the Wegovy pill and a softer print for U.S. injectable Wegovy sales" and attributed the pill shortfall to wholesalers working through inventory. Sales of the injectable Wegovy fell 22 percent from a year earlier, according to BMO.

CagriSema

The second sore point was fresh data from a head-to-head trial pitting CagriSema against Lilly's tirzepatide in type 2 diabetes patients. After 68 weeks, CagriSema matched the Lilly drug on weight loss but failed to beat it on blood-sugar control.

"They are confirming ‌this non-inferiority … which really just means that it’s no better than Lilly’s products," said Jyske Bank analyst Henrik Hallengreen Laustsen. The reading lands a week after Novo's experimental cardiovascular drug ziltivekimab failed to reduce major heart events in a late-stage trial, complicating the company's push to diversify beyond obesity and diabetes.

What's next

Novo executives had not yet held their post-earnings analyst call, scheduled for Wednesday morning. On that call, Chief Executive Mike Doustdar was expected to address competitive strategy, the rising obesity-drug competition and the path forward for CagriSema, which could receive an FDA decision in the second half of the year.

Lilly reports its own second-quarter earnings Wednesday, in what BioSpace called a "battle of the obesity heavyweights."