Cagrilintide vs Semaglutide
An evidence-first, side-by-side comparison. We compare what the research supports — not marketing claims.
Last updated
Evidence grade
Human RCT
Human RCT
What that means
Randomized controlled trials in humans — the strongest evidence we grade.
Randomized controlled trials in humans — the strongest evidence we grade.
Status
In clinical trials
FDA-approved
Mechanism
Cagrilintide is a long-acting analog of amylin, a hormone co-secreted with insulin by pancreatic beta cells. Amylin promotes satiety, slows gastric emptying, and suppresses glucagon — an appetite-regulation route that is mechanistically distinct from the GLP-1/GIP incretin pathway. That distinction is the whole point of the program: because amylin and GLP-1 reduce appetite through different signaling, combining cagrilintide with semaglutide (the CagriSema combination) is expected to be additive rather than redundant. Engineered for once-weekly dosing to match its semaglutide partner.
Semaglutide is a long-acting GLP-1 receptor agonist. It mimics the gut incretin hormone GLP-1: slowing gastric emptying, acting on appetite centers in the hypothalamus to reduce hunger and food intake, and enhancing glucose-dependent insulin secretion. The appetite effect is the one that drives the weight loss — people simply eat less and feel full sooner. Structural modifications (a fatty-acid chain that binds albumin) give it a long enough half-life for once-weekly injection, and an oral formulation (Rybelsus) exists for the diabetes indication.
Weight-loss data
Up to ~10.8% mean body-weight reduction at 2.4 mg/week over 26 weeks (phase 2 dose-finding, Lau 2021)
Mean ~14.9% body-weight reduction at 2.4 mg/week over 68 weeks (STEP 1, Wilding 2021)
Goals
Fat loss, Body composition
Fat loss, Body composition, Visceral fat reduction
Key risks
- Not approved by any regulator — investigational, phase 2 only; long-term safety is unknown
- GI effects (nausea, vomiting) are the most common adverse events, as across appetite-suppressing agents
- Injection-site reactions reported in the dose-finding trial
- Boxed warning: in rodents, GLP-1 agonists caused thyroid C-cell tumors; contraindicated in personal or family history of medullary thyroid carcinoma (MTC) or MEN 2. Human relevance is unestablished but the contraindication stands
- GI effects are very common: nausea, vomiting, diarrhea, constipation — usually dose-dependent and worst during dose escalation
- Reports of acute pancreatitis; discontinue if suspected
Regulatory
Under active investigation in human trials; not yet approved.
Approved by the FDA for one or more human indications.