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Novo Nordisk has already conquered the world of weight loss. Millions use its powerful drug to shed pounds. Diabetes patients swear by it. Investors have made fortunes. But now, the Danish pharmaceutical giant is making a bet that could be even bigger, using the same blockbuster drug to treat Alzheimer’s disease.
It’s a gamble with astronomical upside and enormous risk. And we’ll find out by the end of 2025 whether it pays off.
Last month, a senior executive at the company casually dropped what seemed like a bombshell during a conference in Vienna. Ludovic Helfgott, the executive vice-president for product and portfolio strategy, called the company’s Alzheimer’s trial a “lottery ticket”, uncertain, risky, but with astronomical upside if it pays off, as reported by the Financial Times.
By the end of 2025, we’ll know if Novo Nordisk’s bet will transform the company or go bust.
How We Got Here: From Weight Loss Wonder Drug to Brain Medicine
Let’s rewind a bit. Novo Nordisk’s semaglutide (you know it as Ozempic or Wegovy) has been one of the most celebrated pharmaceutical breakthroughs of the decade. It regulates blood sugar, helps people lose weight, reduces heart attack risk, improves kidney function, the list goes on. GLP-1 agonists, as these drugs are called, have become so successful that Novo commands a 62% market share in this space, up from 60% just three years ago.
But here’s the thing: while semaglutide was busy fixing metabolic disorders, scientists noticed something peculiar. According to the FT’s analysis, people taking the drug for diabetes and obesity were showing 40-70% lower rates of Alzheimer’s diagnosis. This wasn’t just anecdotal chatter, this was real-world data from medical records showing a 53% reduction in dementia diagnoses among diabetes patients who had been taking semaglutide for two years.
So Novo did what any ambitious pharma company would do: they decided to test if semaglutide could actually treat Alzheimer’s. Not prevent it, but reverse its effects. The audacity alone is striking because most Alzheimer’s drugs can only slow cognitive decline. Nobody has managed to actually reverse it.
The Trial: Think Big or Go Home
Novo isn’t messing around with a small, exploratory study. The company launched two massive trials called EVOKE and EVOKE+, each involving 1,800 patients across 30 countries over three years and four months. That’s over 3,600 patients total—a scale that neuroscience professor Christian Hölscher called “colossal” in his interview with the FT. He’s never seen dementia trials of this magnitude before.
The trials are rigorously designed with a primary endpoint measuring changes in the Clinical Dementia Rating – Sum of Boxes score over 104 weeks. The timing is crucial. All participants already show amyloid buildup on brain scans, they’re in the early stages of the disease. The trials wrapped up in September 2025, with data expected by year-end. That’s not far away, folks.
If semaglutide works, Novo gains access to an entirely new market. The Alzheimer’s treatment market is projected to grow from $45.99 billion in 2024 to $92.17 billion by 2034 at a 7.20% CAGR, according to market research. Even with modest efficacy, we’re talking about a multi-billion-dollar revenue stream from a drug the company has already developed and optimized for other conditions
Consider the math: If semaglutide secures just 10% market share in the Alzheimer’s space by 2030, it could generate $9.2 billion annually. Combined with its existing diabetes and obesity revenue (projected to hit $61.7 billion by 2033), Novo Nordisk’s total top line could surpass $70 billion, a 150% increase from its 2024 sales. That’s the pharmaceutical equivalent of hitting the lottery.
But Why Would It Work? The Science Behind the Gamble
Here’s where it gets interesting. Nobody’s exactly sure how semaglutide would help Alzheimer’s patients, but there are several plausible theories backed by research.
One leading hypothesis: the drug reduces excess sugar in the brain, which triggers inflammation. This inflammation contributes to the buildup of amyloid and tau proteins—the hallmarks of Alzheimer’s. Martin Lange, Novo’s chief scientific officer, explained to the FT that people with obesity have double the risk of Alzheimer’s, and those with diabetes have triple the risk, likely because poor metabolic control damages the brain.
Another angle: GLP-1 agonists like semaglutide have “very strong effects on systemic inflammation,” according to research at Imperial College London. They may specifically reduce neuroinflammation while improving vascular function and preserving synaptic integrity—key pathways implicated in Alzheimer’s progression.
A third possibility: the drug reduces stroke risk, and strokes contribute to dementia development. Or perhaps it modifies insulin levels, which play a role in tau accumulation. Preclinical data from a phase 2 trial with liraglutide, a similar GLP-1 drug, showed a 50% reduction in brain atrophy and slower cognitive decline.
The beauty of this uncertainty is that Novo only needs one mechanism to work for the drug to succeed. Multiple pathways exist. Semaglutide’s unique multimodal mechanism—addressing inflammation, vascular health, and insulin resistance—positions it as a potential “best-in-class” candidate.
The Skeptics Aren’t Wrong
Not everyone is convinced. Sir John Hardy, a leading molecular biologist at UCL, told the FT he doesn’t expect a positive outcome. He suspects that if GLP-1s do help with dementia, it’s through indirect effects like reducing blood vessel damage rather than directly modifying the disease. And he’s got a point, at least 70% of Alzheimer’s patients have damaged blood vessels in their brains, according to the Alzheimer’s Society.
Plus, there’s a fundamental challenge: the trials focus on people who already have amyloid buildup. If semaglutide only prevents Alzheimer’s before symptoms appear, the trial could fail even if the drug actually works. That’s a crucial distinction that will require careful analysis of the results.
There’s also the broader context to consider. Clinical trials fail at a 90% rate, and even a positive result may face regulatory hurdles or pricing pressures. A negative outcome would not only erase hopes for Alzheimer’s but also cast doubt on semaglutide’s broader therapeutic potential.
Why Investors Are Excited (And Should Stay Cautious)
Novo’s stock has tanked 55% over the past year due to disappointing trial results for a new obesity treatment and stiff competition from Eli Lilly. The company also failed to maintain its lead in the U.S. market, where cheaper alternatives are eating into its market share.
But here’s why investors are suddenly paying attention again: the risk-reward equation has shifted dramatically. Even a small positive result could push the stock up 5-10% according to BMO Capital Markets analyst Evan Seigerman, who noted that “sometimes the long odds aren’t as long as you think.”
For investors, this aligns with the principle of “asymmetric risk”—a small downside for a potentially massive upside.
The Broader Picture
While Novo gambles on Alzheimer’s, it’s also focused on maintaining dominance in metabolic diseases. The company just ended its partnership with telehealth provider Hims, proving it doesn’t need third parties to scale. An oral version of its weight loss drug is expected to be approved later in 2025, making it the first in its class.
Moreover, semaglutide’s dual role in metabolic and neurodegenerative diseases creates a flywheel effect. Patients with diabetes or obesity, who are at higher risk for Alzheimer’s, could be transitioned to semaglutide for secondary prevention, expanding its addressable market beyond the 6 million current Alzheimer’s patients in the U.S. alone.
There are risks, of course. Semaglutide’s U.S. patent expires in December 2031, though it’s already expiring in markets like Canada, China, and Brazil as early as next year. Competitor Eli Lilly’s tirzepatide shows superior weight loss effects (around 20% vs. Novo’s 16%) in some studies, and Eli has proven its ability to scale production quickly. Novo can’t afford to be complacent.
The Bottom Line
Novo Nordisk’s Alzheimer’s trial really is a lottery ticket. If it wins, the company gains a transformational new market and billions in revenue. If it loses, the core diabetes and obesity business is strong enough that the downside is limited.
We’ll know the outcome soon. By year-end 2025, we’ll discover whether this Danish pharmaceutical giant’s boldest bet will revolutionize Alzheimer’s treatment or become a cautionary tale about reaching too far. Either way, it’s one of the most consequential pharmaceutical trials happening right now.
The house may or may not hold all the cards, but Novo is about to place one hell of a bet.
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