Summary: In a prespecified analysis of Chinese adults with overweight or obesity from the phase 3a STEP 7 trial, once-weekly semaglutide 2.4 mg reduced body weight by an estimated 8.3% more than placebo over 44 weeks (95% CI -10.2, -6.4; p<0.0001), and 85.4% versus 26.8% of participants achieved at least 5% weight loss. Gastrointestinal adverse events were common with active treatment.
PICO Summary
| Element | Detail |
|---|---|
| Population | 300 Chinese adults with overweight or obesity (BMI >=27 kg/m2 with a weight-related comorbidity, or >=30 kg/m2), with or without type 2 diabetes; prespecified subgroup of the double-blind, multicentre, phase 3a STEP 7 randomized controlled trial (NCT04251156), China. |
| Intervention | Once-weekly subcutaneous semaglutide 2.4 mg for 44 weeks, alongside a reduced-calorie diet and increased physical activity (n=195). |
| Comparison | Once-weekly placebo plus the same lifestyle intervention; 2:1 randomization (n=105). |
| Outcome | Estimated mean body-weight change at Week 44 was -11.8% with semaglutide versus -3.5% with placebo (estimated treatment difference -8.3%; 95% CI -10.2, -6.4; p<0.0001). A greater proportion achieved at least 5% weight loss with semaglutide than placebo (85.4% vs 26.8%; odds ratio 16.1; 95% CI 8.4, 30.9; p<0.0001). Adverse events occurred in 92.3% versus 82.9%, driven by gastrointestinal disorders (64.6% [126/195] vs 33.3% [35/105]). |
Semaglutide 2.4 mg in Chinese adults (STEP 7)
RCT subgroup · overweight/obesity · 44 weeks
Once-weekly semaglutide 2.4 mg cut body weight by an estimated 8.3 percentage points more than placebo over 44 weeks in Chinese adults, with most reaching at least 5% weight loss. Gastrointestinal effects were common.
Expert Commentary
This prespecified analysis confirms that the weight-loss efficacy of once-weekly semaglutide 2.4 mg seen in global STEP trials is reproduced in a Chinese population, with an estimated 8.3 percentage-point advantage over placebo at 44 weeks and a striking sixteen-fold odds of reaching the 5% threshold. The effect is internally consistent and clinically meaningful, and the gastrointestinal tolerability profile mirrors the broader semaglutide programme. Two caveats temper enthusiasm. First, this is a subgroup of a larger trial rather than a standalone study, so it is best read as confirmatory and supportive rather than definitive on its own; the modest sample, while adequate for the primary endpoint, limits precision for rarer safety signals. Second, the trial was sponsored by the manufacturer and several authors are company employees, which warrants the usual caution even where the data appear robust. The 44-week horizon also leaves durability and post-discontinuation weight regain unaddressed. Can I use this with my patients? Yes, for Chinese adults with overweight or obesity who meet the BMI thresholds and can tolerate the dose-escalation schedule, this supports semaglutide 2.4 mg as an evidence-based adjunct to lifestyle measures. Clinicians should counsel proactively on gastrointestinal effects and frame treatment as a long-term commitment rather than a fixed course. Longer follow-up and pragmatic real-world data would strengthen the case further.
References
Gu W, Lu Y, Ye X, Yuan G, Liu D, Shen Z, et al. Efficacy and safety of once-weekly semaglutide 2.4 mg for weight management in participants from China: A prespecified analysis of the STEP 7 randomized clinical trial. Diabetes Obes Metab. 2025;27(5):2540-2551. doi:10.1111/dom.16253