Biohacking Kompakt

Podcast episode 156 (in German)

Update: Retatrutide – the first head-to-head with Ozempic

November 8, 2026

For the first time, retatrutide has gone up directly against semaglutide, the active substance in Ozempic, and according to the manufacturer it took off more than twice as much weight. In addition, the large phase 3 trials have now been peer-reviewed, with new data on sleep apnea, knee osteoarthritis and type 2 diabetes.

What it is about

The first update in the series that, from now on, revisits one topic every Sunday and asks what has happened since. A lot has happened with retatrutide since episode 106: the phase 3 trials TRIUMPH-1 and TRIUMPH-2 have been published after peer review, a separate paper on sleep apnea has been added, and the manufacturer reports the first direct comparison with semaglutide. Once again the episode sorts out which figure belongs to whom: everyone who was enrolled in a trial, or only those who continued treatment as planned. Then come the people who are not waiting for approval: an analysis of Reddit posts that has now been peer-reviewed, a case report from Switzerland and a laboratory test of purchased products. In the BK-Score, the safety data rating rises from 6 to 7 because safety is better studied, not because the substance is more harmless; human evidence stays at 9, track record of use at 4.

Key points

  • In the first direct comparison with semaglutide at the highest dose approved for Ozempic, 1,298 adults with type 2 diabetes lost 19.5 and 20.9 percent of their weight in 80 weeks on retatrutide and 9.4 percent on semaglutide; long-term blood sugar (HbA1c) fell by 2.2 percentage points in both retatrutide groups and by 1.8 on semaglutide. These are manufacturer figures from October 28, 2026, not yet peer-reviewed.
  • Nausea was practically level in this comparison: 23.8 percent at the highest level versus 21.3 percent on semaglutide, and constipation was even less frequent on retatrutide. Higher were skin tingling (dysesthesia), at 6.5 versus 2.7 percent, and discontinuations due to side effects, at 7.9 versus 2.7 percent.
  • An independent review of 38 trials without industry funding in the Annals of Internal Medicine arrives, after subtracting placebo, at 22.1 percent weight loss for retatrutide, 19.0 percent for tirzepatide and 14.8 percent for semaglutide; the ranges for tirzepatide overlap.
  • On October 21, 2026, a separate paper on sleep apnea appeared in the New England Journal of Medicine, covering 243 people without and 448 with type 2 diabetes, all with moderate to severe sleep apnea and at baseline on average 58.6 and 55.9 breathing interruptions per hour, respectively. After 80 weeks, those without diabetes had 34.3 fewer interruptions at the middle level, 9.9 fewer on placebo, and those with diabetes 25.4 fewer at the highest level versus 10.3; without diabetes, the highest level brought no more than the middle one.
  • In the peer-reviewed publication of TRIUMPH-1 (New England Journal of Medicine, September 29, 2026), pain on a scale up to 10 fell by 3.6 points at the highest level in 574 people with knee osteoarthritis, and by 1.9 on placebo.
  • TRIUMPH-2 in the Lancet: 1,152 people with overweight and type 2 diabetes lost, calculated across everyone randomized, 18.8 percent of their weight in 80 weeks at the highest level and 5.1 percent on placebo; Lilly gives 20.8 percent for the same trial, counting only those who continued treatment as planned. Newly named is blood pressure falling too low: 6 percent at the highest level, under 1 percent on placebo.
  • The Reddit analysis by the University of Pennsylvania, covering 148,640 posts and comments from 27 forums, was published after peer review in JAMA Network Open on October 14, 2026, with unchanged figures: of 7,823 evaluable users, 17.1 percent reported more appetite, 15.2 percent fatigue, 12.4 percent more energy and only then 11.6 percent nausea.

Chapters (episode in German)

  1. 0:00Number of the week and the first update
  2. 1:03The head-to-head: retatrutide versus Ozempic
  3. 2:40The catch: skin tingling and dropouts
  4. 3:24Tirzepatide: no head-to-head yet, an indirect comparison
  5. 4:11Sleep apnea and knees, now peer-reviewed
  6. 6:05TRIUMPH-2 in diabetes and blood pressure falling too low
  7. 7:01Users: Reddit, a case report and grey-market products
  8. 9:12What stayed the same, approval and the BK-Score

Where the data stop

The figures from the head-to-head with semaglutide come from an Eli Lilly press release and count only the people who continued treatment as planned; the release gives no value across everyone randomized. Against tirzepatide there is still no direct comparison; according to the trial registry, the TRIUMPH-5 trial is due to be completed in November 2026. The review in the Annals relies mainly on phase 2 trials and is an indirect comparison. Still missing are phase 3 data on muscle mass and data on what happens after stopping; the large heart outcomes trial is not due to be completed until February 2029.

As of November 2026, retatrutide is not approved anywhere. Lilly intends to file for FDA approval in the first quarter of 2027; for Europe, no submission is publicly known. In the US, the manufacturer has run a compassionate-use program since June 2026 for severe individual cases in which standard therapy has been exhausted; in Germany, retatrutide is available as a tested medicinal product only in trials.

What is sold outside of trials is not the tested study drug. The Reddit figures are based on self-reports, unknown products and often several peptides at once, as the authors themselves write. In a peer-reviewed case report from Switzerland, a self-proclaimed life coach without medical training injected a young woman for 4 weeks with an untested product said to contain retatrutide; 5 days of nausea and vomiting followed that nothing would relieve, and the woman did not consider the injections to be a medicine. In a laboratory test commissioned by the broadcaster CBS, 2 of 3 purchased products matched retatrutide; the third did not look like a peptide and contained bacteria. According to US media reports, 2 death reports in connection with such products have been filed with the FDA; whether the substance was the cause has not been established.

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Published on November 8, 2026.

The topic in the database

  • The strongest weight-loss agent from the studies so far: a triple agonist from Eli Lilly at GLP-1, GIP and glucagon receptors. In phase 2 it was …Retatrutide

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Information only, not medical advice and not a usage or dosage recommendation. Prescription-only and unapproved substances belong in the hands of a physician. Content as of: 2026-11-10.