What it is
Cagrilintide is a long-acting analogue of amylin, developed by Novo Nordisk. Amylin is a hormone made by the same pancreatic beta cells that make insulin, and it is released alongside insulin after a meal. Natural amylin lasts minutes and clumps easily. Cagrilintide was engineered to stay soluble and to last about a week in the blood, so it can be injected once weekly.
On its own, cagrilintide reached phase 2. Its real commercial role is as the partner drug in CagriSema, a weekly combination with semaglutide.
How it works
Amylin works through a different pathway from GLP-1. It acts mainly on the brainstem, where it signals fullness, and it slows stomach emptying and suppresses glucagon after meals. Because the receptors are different, the idea is that amylin and GLP-1 agonism add together rather than compete.
An older, short-acting amylin analogue, pramlintide, has been used with mealtime insulin in diabetes, but it needs injections before each meal. Cagrilintide's long half-life is what made a weekly amylin drug possible.
What the research found
All of the key data is human.
Phase 2, cagrilintide alone
Lau and colleagues randomised 706 adults with overweight or obesity to one of five weekly cagrilintide doses (0.3 to 4.5 mg), 99 to daily liraglutide 3.0 mg, and 101 to placebo, for 26 weeks.
- Mean weight loss was 6.0% to 10.8% across cagrilintide doses, against 3.0% on placebo.
- The top dose, 4.5 mg, produced 10.8% (11.5 kg) vs 9.0% (9.6 kg) on liraglutide.
Phase 1b, with semaglutide
Enebo and colleagues gave 96 adults cagrilintide at doses from 0.16 to 4.5 mg on top of semaglutide 2.4 mg, with a semaglutide-plus-placebo comparison group, over 20 weeks. The half-life of cagrilintide was 159 to 195 hours. At week 20, weight loss was 15.7% with cagrilintide 1.2 mg and 17.1% with 2.4 mg, against 9.8% with semaglutide alone. The 2.4 mg dose became the phase 3 dose.
REDEFINE 1, phase 3
REDEFINE 1 randomised 3,417 adults with overweight or obesity to cagrilintide 2.4 mg plus semaglutide 2.4 mg, either drug alone, or placebo for 68 weeks. Mean weight change with the combination was -20.4%, against -3.0% on placebo, a difference of 17.3 percentage points.
Side effects reported in studies
The pattern is the same as GLP-1 drugs: mostly gastrointestinal. In the phase 2 trial, 41% to 63% of people on cagrilintide had gastrointestinal events such as nausea, constipation and diarrhoea, against 32% on placebo. In REDEFINE 1, gastrointestinal adverse events affected 79.6% on the combination and 39.9% on placebo, and were described as mainly transient and mild to moderate. In the phase 1b study, 37% of all reported adverse events were gastrointestinal.
The side effect management guide covers how these effects are handled in GLP-1 trials.
Cagrilintide vs semaglutide
| Cagrilintide | Semaglutide | CagriSema | |
|---|---|---|---|
| Hormone mimicked | Amylin | GLP-1 | Both |
| Longest trial | 26 weeks alone (phase 2) | 68 weeks (STEP-1) | 68 weeks (REDEFINE 1) |
| Status | Investigational | Approved (Ozempic, Wegovy) | Investigational |
Status in the Philippines
Cagrilintide is not approved by any regulator and is not registered with FDA Philippines, so it cannot be sold as a medicine here. It appears locally as a research compound, and far less often than tirzepatide or retatrutide. Semaglutide, its partner in CagriSema, is registered in the Philippines as Ozempic and Wegovy.
Storage
Research vials come as a lyophilised powder and are best kept refrigerated. Once reconstituted, keep the vial at 2 to 8°C and away from the freezer compartment. Tropical heat and brownouts are the main threat to peptide stability in the Philippines, so plan for a cooler during outages. See the reconstitution calculator for mixing arithmetic.
