The standard maintenance dose of Wegovy is 2.4 mg a week. STEP UP, a phase 3b randomised trial published in The Lancet Diabetes & Endocrinology, tested three times that — 7.2 mg — against both the standard dose and placebo over 72 weeks. Average weight loss was 20.7% on the high dose, 17.5% on 2.4 mg, and 2.4% on placebo. For anyone who has plateaued on the standard dose, or who has been comparing semaglutide unfavourably with tirzepatide, this is the trial that matters.
What the numbers show
From a mean baseline of 113 kg, 20.7% works out to roughly 23 kg for the average participant. The gap over the standard dose is about 3.2 percentage points — real, but smaller than the jump from placebo to any active dose, which is the more important comparison for anyone deciding whether to treat at all.
The more striking result is at the top end. A third of participants on 7.2 mg — 33.2% — lost 25% or more of their body weight, against 16.7% on 2.4 mg and nobody at all on placebo. Doubling the proportion reaching that threshold matters more than moving an average, because it is the difference between a good result and a transformative one for the people who respond best.
Safety followed the familiar pattern: adverse events were mostly gastrointestinal, the large majority mild to moderate, and they diminished over time rather than persisting.
What it means for the comparison with tirzepatide
The head-to-head trial that established tirzepatide’s advantage used semaglutide at 2.4 mg, because that was the approved maximum. It produced 20.2% for tirzepatide against 13.7% for semaglutide. Semaglutide at 7.2 mg reaches 20.7% — numerically above tirzepatide’s figure in that trial.
That comparison is tempting and it is not valid. These are different trials, with different participants, different baseline weights and different designs, and comparing across them is precisely the error that produces confident wrong answers. The honest statement is narrower: the gap between the two drugs looks smaller at semaglutide’s higher dose than the head-to-head trial suggested, and only a new head-to-head at 7.2 mg would establish by how much. No such trial has reported.
You can already buy this dose
Unlike most trial results, this one describes something already on the shelf. Novo Nordisk sells a Wegovy HD pen at 7.2 mg through its own self-pay pharmacy at $399 a month — $50 more than the $349 charged for the standard 0.25 to 2.4 mg pen. So the practical question is not whether the higher dose will eventually be available, but whether roughly three extra percentage points of average weight loss, and a doubled chance of exceeding 25%, is worth $600 a year.
That is a calculation only the person paying can make, and it depends heavily on which outcome you are aiming at. For someone tracking the average, the increment is modest. For someone who has stalled short of their target on 2.4 mg, the threshold data is the more relevant number.
What is not yet settled
Whether a higher dose costs more is a separate question from whether it works better, and the two do not move together automatically — the high-dose pen currently carries its own price on the self-pay ladder, which we cover in our cost breakdown. Tolerability at 7.2 mg over years rather than 72 weeks is unknown. And as with every trial in this class, weight regain after stopping is not addressed by a study that measures people while they are still taking the drug.
