Feb 23 (Reuters) - Novo Nordisk's NOVOb.CO next-generation weight-loss drug CagriSema was less effective than Eli Lilly's LLY.N Zepbound in a head-to-head trial, a fresh blow to the Danish drugmaker's efforts to reclaim its early lead in the booming obesity drug market.

Below are some reactions from analysts.

Michael Leuchten, Jefferies

"Where all of this is a headache is that Novo's terminal value pivots around amycretin, which like CagriSema is a GLP-1/amylin combination (albeit in one molecule), so the failure of REDEFINE-4 and commercial uncertainty versus competition does little to calm long-term investor nerves."

"Investors' focus will likely now turn to management's M&A strategy, in our view, with our forecasts suggesting potential for up to $35 billion to be spent this year. Feedback suggests that investors wish to see this spend in adjacent therapy areas outside of obesity and diabetes, with our view that this should buy management time to reinvest its obesity portfolio."

Evan David Seigerman, BMO Capital Markets

"We struggle to identify a reason why a patient would be prescribed CagriSema vs. Tirzepatide if/when the Novo product is approved/available."

"We see no way to spin this one as a win for Novo. It is striking to hear management concede that their competitor's product outperformed in a trial they sponsored and designed. We believe Novo needs more than just the Wegovy pill to right this ship - a complete strategy overhaul is in order."

Chris Schott, J.P. Morgan

"We see this result confirming Zepbound as a clear market leader for now and positioning LLY for continued share gains for the drug over time. While CargiSema should bring a more competitive offering to market for Novo, we believe it will be difficult for Novo to dislodge market share from LLY."

"As a result, we expect LLY will have a longer runway for share gains for Zepbound beyond 2026."

Srikripa Devarakonda, Truist Securities

"Cagrisema is a potent drug and we continue to keep track of additional trial data, we believe these data maintain LLY's dominance in obesity landscape at least for the near future."

"Best-in-class profile coupled with improved access and supply, and increasing demand are expected to support LLY's position in the landscape, in our view."

"While we await detailed data, we note that discontinuation rates with tirzepatide were lower vs. semaglutide; based on data so far, we believe Cagrisema is unlikely to see a safety benefit vs. tirzepatide."

Courtney Breen, Bernstein

"This trial now emphasizes that Novo's challenges

remain and Lilly continues to weather whatever Novo throws at them."

Breen said they were already skeptical over the potential for Novo to compete directly with Lilly through Cagrisema, given manufacturing challenges and limited benefits over tirzepatide. The likely launch of Lilly's next-generation drug retatrutide - which has a higher efficacy - around the same time is likely to further limit Novo's prospects, Breen added.

James Gordon, Barclays

"While we continue to see CagriSema as approvable, today's RD4 (trial) results will likely mean driving uptake is an uphill battle vs. a more effective and better tolerated incumbent, leaving Novo little to compete on apart from price."

(Reporting by Puyaan Singh, Mariam Sunny and Mrinalika Roy in Bengaluru; Editing by Leroy Leo)

((mrinalika.roy@thomsonreuters.com;))