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STEP 7: Semaglutide in East Asian Populations

Last verified May 2026 · Phase 3a · Finished; headline results published March 2024 · NCT04251156 ↗

By Ruth Calder · Enforcement Editor
Editorially reviewed (not clinically reviewed). Not medical advice · How we verify contentLast reviewed

Obesity thresholds, body composition and metabolic risk at a given BMI differ meaningfully across populations, which is why several countries use lower BMI cut-offs for intervention than the United States does. A drug's effect can transfer while the eligibility criteria do not, or the reverse. STEP 7 is smaller and shorter than STEP-1 — 375 participants over 44 weeks against 1,961 over 68 — so its figures are not directly comparable, but its direction and magnitude are consistent.

Enrollment
375
Duration
44 weeks of weekly injections, the first 16 spent climbing from 0.25 mg to the 2.4 mg maintenance dose, then standard safety follow-up
Drug
Semaglutide 2.4 mg (Wegovy)
Population
Adults 18 and over living with excess weight or obesity, recruited mostly from East Asian populations at 23 centers spread across China, Hong Kong, South Korea and Brazil. People with and without type 2 diabetes could enroll, and randomization was balanced for it. ⚠ Eligibility used the Asian-population BMI thresholds, which mark obesity at a lower number than the WHO global cutoff — so a participant here may not have qualified for a US trial. Of 448 screened between December 2020 and August 2022, 375 were randomized, two to one in favor of the drug.

Primary endpoint

How much body weight came off over 44 weeks, and how many lost at least 5%

Treatment arm

Mean body-weight change -12.1% (SE 0.5); 5% threshold reached by 203/238 (85%)

Comparator

Mean body-weight change -3.6% (SE 0.7); 5% threshold reached by 36/116 (31%)

Treatment difference: Mean weight change: estimated treatment difference -8.5 percentage points (95% CI -10.2 to -6.8; p<0.0001). 5% threshold: odds ratio 13.1 (95% CI 7.4 to 23.1; p<0.0001).

⚠ Do not line the 12.1% up against the 14.9% from the flagship trial as though they were the same measurement. This trial ran 24 weeks shorter, and weight is still coming off at that point in every trial of this drug. Most of the gap is the calendar, not the population.

Secondary endpoints

EndpointTreatmentComparatorDifference
Lost at least a tenth of body weight

Two thirds got there — the level where sleep apnea, fatty liver and blood sugar markers typically start to move.

Semaglutide 2.4 mg: 66%Placebo: 11%Confirmatory secondary endpoint; p<0.0001 vs placebo
Lost at least 15%

Two in five, at 44 weeks rather than 68 — a magnitude that used to be associated only with surgery.

Semaglutide 2.4 mg: 42%Placebo: 3%Confirmatory secondary endpoint; p<0.0001 vs placebo
Inches off the waist

★ Arguably the most relevant row on this page. In East Asian populations, abdominal fat pushes cardiometabolic risk up at lower BMI figures than it does elsewhere — which makes the tape measure a better guide here than the scale.

Semaglutide 2.4 mg: -9.4 cmPlacebo: -3.1 cmEstimated treatment difference -6.3 cm; p<0.0001 vs placebo
Top blood-pressure number

About 3 points beyond placebo — smaller than the 68-week trials reported, in line with the shorter run.

Semaglutide 2.4 mg: -4.0 mmHgPlacebo: -0.7 mmHgEstimated treatment difference -3.3 mmHg; nominal p<0.05 vs placebo
Three-month average blood sugar

This trial mixed people with and without diabetes, and as expected the diabetes group's blood sugar fell further in absolute terms.

Semaglutide 2.4 mg: -0.5 percentage pointsPlacebo: -0.1 percentage pointsEstimated treatment difference -0.4 percentage points; p<0.0001 vs placebo
Blood sugar after an overnight fast

Lower than placebo, matching the direction seen in the multinational trials.

Semaglutide 2.4 mg: lower than placeboPlacebo: minimal changeStatistically significant favoring semaglutide; full numeric details in trial supplement
Total cholesterol

A modest reduction. ⚠ As everywhere in this class, the lipid changes are small next to the weight changes and are no substitute for a statin.

Semaglutide 2.4 mg: modest reductionPlacebo: minimal changeFavors semaglutide; nominal significance reported
How people rated their own physical functioning

Improved more than placebo, on the same questionnaire the other trials in this program used.

Semaglutide 2.4 mg: improvementPlacebo: smaller improvementFavors semaglutide; magnitudes reported in supplement

Adverse events

EventTreatment rateComparator rate
Any adverse event at all

⚠ Read both columns: 93% on the drug and 86% on placebo. When almost everyone in both arms reports something, the raw rate says little — the gap is what matters, and here it is stomach and bowel effects.

93% (231/249)86% (108/126)
Stomach and bowel problems

The dominant category, covering nausea, diarrhea, vomiting and constipation, at roughly twice the placebo rate.

67% (168/249)36% (45/126)
Nausea

The most frequent single complaint, peaking while the dose was climbing and easing afterwards — the same curve every trial of this drug shows.

Reported as most-common single GI eventLower than semaglutide arm
Diarrhea

Common and usually temporary.

Common GI event in semaglutide armLess common on placebo
Vomiting

More frequent than on placebo, mostly mild to moderate.

More frequent than placeboLess common
Serious adverse events

Low single digits in both arms, and nothing appeared here that the global program had not already seen.

Reported in both arms at low single-digit percentagesSimilar order of magnitude
Stopped the drug over a side effect

Single digits, almost all of it stomach and bowel trouble, in line with the rest of the program.

Single-digit percentage; predominantly GI-drivenLower than semaglutide arm

Subgroup analyses

  • The 300 Chinese participants, analyzed separately as planned: 11.8% below starting weight on semaglutide against 3.5% on placebo, a gap of 8.3 percentage points; 85.4% cleared the 5% mark against 26.8%

    ★ This is the analysis that matters for anyone reading the trial as evidence about China specifically, and it lands essentially on top of the full-trial result.

  • People who also had type 2 diabetes: Weight favored semaglutide, and blood sugar fell further in absolute terms than in those without diabetes

    ⚠ The same blunting seen everywhere else in this class: diabetes means less weight comes off, more blood sugar does.

  • People without diabetes: A larger weight difference against placebo than the diabetes group achieved

    The gap between these two subgroups mirrors the gap between the separate non-diabetic and diabetic trials in the same program.

Clinical significance

The result supports generalizing semaglutide's effect beyond the populations of the pivotal program, which matters both scientifically and for regulatory approval outside the US and EU. ⚠ At 44 weeks it is shorter than the 68-week STEP trials, and weight loss in this class is still accumulating at that point, so the −12.1% should not be set beside −14.9% as though the two were measured the same way.

Who sells semaglutide, and for how much

This trial tested Semaglutide 2.4 mg (Wegovy). Across the 584 sellers on this register, 327 publish a standing monthly cash price for compounded semaglutide, from $59 a month, with a median of $175.

⛔ None of those sellers was in this trial. A compounded preparation is not the product studied here: no agency has reviewed that specific preparation for safety, effectiveness or manufacturing quality, and its concentration is set by whichever pharmacy filled it. The result above is the strongest evidence available for semaglutide and it was generated on something else. Every seller, with its price record.

Frequently Asked Questions

On its primary endpoint — How much body weight came off over 44 weeks, and how many lost at least 5% — the treatment arm recorded Mean body-weight change -12.1% (SE 0.5); 5% threshold reached by 203/238 (85%) against Mean body-weight change -3.6% (SE 0.7); 5% threshold reached by 36/116 (31%) for the comparator. Mean weight change: estimated treatment difference -8.5 percentage points (95% CI -10.2 to -6.8; p<0.0001). 5% threshold: odds ratio 13.1 (95% CI 7.4 to 23.1; p<0.0001).. ⚠ Do not line the 12.1% up against the 14.9% from the flagship trial as though they were the same measurement. This trial ran 24 weeks shorter, and weight is still coming off at that point in every trial of this drug. Most of the gap is the calendar, not the population.
375 participants, over 44 weeks of weekly injections, the first 16 spent climbing from 0.25 mg to the 2.4 mg maintenance dose, then standard safety follow-up. It was a Phase 3a trial, finished; headline results published March 2024. Registered as NCT04251156, which you can look up yourself rather than taking anyone's summary for it.
Adults 18 and over living with excess weight or obesity, recruited mostly from East Asian populations at 23 centers spread across China, Hong Kong, South Korea and Brazil. People with and without type 2 diabetes could enroll, and randomization was balanced for it. ⚠ Eligibility used the Asian-population BMI thresholds, which mark obesity at a lower number than the WHO global cutoff — so a participant here may not have qualified for a US trial. Of 448 screened between December 2020 and August 2022, 375 were randomized, two to one in favor of the drug. ⚠ A trial result describes the population it was measured in. If you differ from it materially — in age, in baseline weight, in whether you have diabetes — the number is context rather than a prediction.
The most commonly reported were any adverse event at all (93% (231/249) against 86% (108/126) on comparator), stomach and bowel problems (67% (168/249) against 36% (45/126) on comparator), nausea (Reported as most-common single GI event against Lower than semaglutide arm on comparator). ⚠ Read both columns: 93% on the drug and 86% on placebo. When almost everyone in both arms reports something, the raw rate says little — the gap is what matters, and here it is stomach and bowel effects. Rates come from this trial's population under its own dose-escalation schedule; a faster or slower titration changes what people experience.
Secondary endpoints included lost at least a tenth of body weight (Semaglutide 2.4 mg: 66% against Placebo: 11%); lost at least 15% (Semaglutide 2.4 mg: 42% against Placebo: 3%); inches off the waist (Semaglutide 2.4 mg: -9.4 cm against Placebo: -3.1 cm). ⚠ Secondary endpoints are weaker evidence than the primary one — a trial is powered for its primary outcome, and the rest are read as supporting rather than as findings in their own right.
No, and this matters because the number gets used that way. STEP 7 tested Semaglutide 2.4 mg (Wegovy) — the FDA-approved product, made by its manufacturer under Good Manufacturing Practice, at the doses and schedule the protocol specified. A compounded preparation of semaglutide is a different product: no agency has reviewed that specific preparation for safety, effectiveness or manufacturing quality, and its concentration is set by whichever pharmacy filled it. ⛔ A seller quoting this trial's result beside a compounded price is quoting evidence that was generated on something they are not selling. That is not the same as saying compounded semaglutide does not work — it is saying nobody measured it here.
It cannot tell you that. A trial reports an average across a defined population under a fixed protocol, with monitoring and adherence support most people do not get. It is the best evidence available and it is still a distribution rather than a promise — some participants lost far more than the mean and some lost nothing. What it is genuinely good for is comparing options against each other, which is what the rest of this section is for.

References

  1. 1.Mu Y, Bao X, Eliaschewitz FG, Hansen MR, Kim BT, Koroleva A, Ma RCW, Yang T, Zu N, Liu M; STEP 7 Study Group. Efficacy and safety of once weekly semaglutide 2·4 mg for weight management in a predominantly east Asian population with overweight or obesity (STEP 7): a double-blind, multicentre, randomised controlled trial. Lancet Diabetes Endocrinol. 2024. PMID: 38330988.
  2. 2.Gu W, Lu Y, Ye X, Yuan G, Liu D, Shen Z, Zu N, Mu Y. 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. PMID: 40069849.
  3. 3.U.S. National Library of Medicine. Research Study Investigating How Well Semaglutide Works in People From East Asia Suffering From Overweight or Obesity (STEP 7) — Study Record. ClinicalTrials.gov, NCT04251156. 2024. https://clinicaltrials.gov/study/NCT04251156

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