STEP 7: Semaglutide in East Asian Populations
Last verified May 2026 · Phase 3a · Finished; headline results published March 2024 · NCT04251156 ↗
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
| Endpoint | Treatment | Comparator | Difference |
|---|---|---|---|
| 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 cm | Placebo: -3.1 cm | Estimated 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 mmHg | Placebo: -0.7 mmHg | Estimated 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 points | Placebo: -0.1 percentage points | Estimated 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 placebo | Placebo: minimal change | Statistically 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 reduction | Placebo: minimal change | Favors 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: improvement | Placebo: smaller improvement | Favors semaglutide; magnitudes reported in supplement |
Adverse events
| Event | Treatment rate | Comparator 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 event | Lower than semaglutide arm |
| Diarrhea Common and usually temporary. | Common GI event in semaglutide arm | Less common on placebo |
| Vomiting More frequent than on placebo, mostly mild to moderate. | More frequent than placebo | Less 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 percentages | Similar 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-driven | Lower 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 556 sellers on this register, 283 publish a standing monthly cash price for compounded semaglutide, from $79 a month, with a median of $174.
⛔ 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
References
- 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.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.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