The drugmaker behind the medical phenomenon semaglutide, the key ingredient in Wegovy and Ozempic, will go into its full-year results on Wednesday more bruised than it has ever been since its GLP-1 diabetes medications became popularized as weight loss tools for the masses.

In December, shares in Novo Nordisk plunged after its newest weight loss drug, CagriSema, disappointed in weight loss trials. The GLP-1-based drug only helped participants shed an average of 22.7% of their original weight, below the targeted 25% weight loss, and came with challenging side effects.

The company has lost 30% of its value in the last six months, largely attributable to its disappointing results shared on December 20. It was briefly dethroned as Europe’s most valuable company by LVMH before the luxury giant was hit by disappointing earnings results.

The defining player in ending Novo Nordisk’s honeymoon period, though, is Eli Lilly, the U.S. pharmaceutical group that has stormed to market with tirzepatide, the ingredient that fuels its competing weight loss drug Mounjaro/Zepbound.

Investors are more cognizant of Eli Lilly’s presence since it hit markets and offered an alternative to Wegovy. One Eli Lilly–backed trial showed that Zepbound was better than Wegovy at helping users cut weight. 

The specter of fresh tariffs under the Donald Trump administration, in addition to a showdown with U.S. lawmakers over the price of Ozempic, has further amplified threats from America, Novo Noordisk’s biggest market.

However, according to a report from Reuters, Novo Nordisk is playing its own major role in perturbing investors and keeping its stock depressed well below recent highs. The publication spoke with more than a dozen investors and analysts

In its CagriSema trial, only 57.3% of patients took the full dose throughout the trial period, with other participants opting to lower their dose. 

The relatively low share of participants taking the full dose of CagriSema could explain the lower-than-expected average weight loss. But it’s the hushed nature of the flexible protocol that has concerned investors. 

Previous trials for semaglutide allowed users to trial a lower dose if they were experiencing “unacceptable side effects.” Indeed, Reuters spoke to patients on the trial who anonymously disclosed side effects, including nausea, constipation, fatigue, and extended periods with a very low appetite.

Novo Nordisk, analysts argue, hasn’t explained why flexible dosing was allowed on the CagriSema trial, leaving investors’ imaginations to run amok. 

“With CagriSema, people are assuming the worst—on efficacy the drug is not better than Lilly’s tirzepatide, on tolerability that it is worse, and that it is harder to manufacture,” Barclays analyst Emily Field told Reuters.

“We don’t necessarily agree with all those viewpoints, but given lack of additional commentary from the company, I understand why people are taking such a negative approach.”

Wednesday’s Q4 earnings release could shed more light on the vaguer aspects of the CagriSema trial. Analysts are unlikely to hold their breaths, though, with Novo planning to release full trial results later this year.

A representative for Novo Nordisk declined to comment, citing the media blackout period in advance of financial results.