CagriSema — GLP-1 + Amylin Combination Profile

What Is CagriSema?

CagriSema is Novo Nordisk’s once-weekly subcutaneous obesity candidate. Unlike tirzepatide (a single engineered peptide) or the retatrutide profile compound (also a single peptide), CagriSema is a combination of two separate, pharmacologically distinct molecules:

• Cagrilintide 2.4 mg — a long-acting amylin analog that activates amylin and calcitonin receptors.
• Semaglutide 2.4 mg — the GLP-1 receptor agonist already marketed as Wegovy (obesity) and Ozempic (type 2 diabetes).

The original plan was to deliver both peptides via a single-chamber co-formulated pen. In May 2026, Novo Nordisk dropped that device and confirmed CagriSema will launch as a dual-pen — cagrilintide and semaglutide delivered together as two separate pens rather than one combined cartridge. Active ingredients, dosing, and the REDEFINE evidence base are unchanged. See Fierce Biotech coverage of Novo’s CEO confirming no change to the overall launch timeline.

CagriSema sits at the top of Novo Nordisk’s next-generation obesity pipeline. If approved, it becomes the company’s flagship post-semaglutide asset and the first GLP-1+amylin combination on market for chronic weight management. For regulatory tracking, see Is CagriSema approved?

Mechanism of Action

The CagriSema combination hypothesis is that amylin and GLP-1 pathways reinforce each other to produce additive weight loss beyond either component alone:

• GLP-1 receptor (semaglutide): Central appetite suppression, slowed gastric emptying, improved glycemic control. Same mechanism driving Wegovy’s efficacy.
• Amylin / calcitonin receptors (cagrilintide): Activates receptors in the area postrema and other brainstem satiety circuits, reducing food intake through a pathway distinct from GLP-1. Amylin is physiologically co-secreted with insulin from pancreatic beta cells.

Pharmacologically, CagriSema differs from the other leading obesity candidates in three ways. It differs from pure GLP-1 agonists by adding the amylin arm. It differs from GLP-1/GIP agonists (tirzepatide) by replacing GIP with amylin. And it differs from glucagon-containing agonists like survodutide and retatrutide by not targeting the energy-expenditure pathway at all — CagriSema’s weight loss is driven entirely by appetite and satiety mechanisms.

Development Stage & REDEFINE Programme

CagriSema is in Phase 3 across a broad REDEFINE programme spanning obesity, obesity with type 2 diabetes, and head-to-head comparisons. Novo Nordisk filed the CagriSema NDA on December 18, 2025. As of May 23, 2026, the FDA decision is expected in late 2026 if standard review timing holds; no public PDUFA date has been confirmed.

NDA timeline: Filed December 18, 2025. Standard FDA review timelines put the decision in late 2026; no exact PDUFA date has been publicly confirmed. The filing pre-dates the REDEFINE-4 readout and rests on placebo-controlled REDEFINE-1, so a missed non-inferiority margin against tirzepatide does not, by itself, block approval — the FDA reviews total evidence of safety and efficacy versus placebo.

Efficacy Data — REDEFINE 1 and REDEFINE 4

REDEFINE 1 — The Pivotal Placebo-Controlled Trial

REDEFINE 1 was a 68-week randomised, double-blind, placebo-controlled Phase 3 trial in adults with obesity. CagriSema produced approximately 22.7% mean weight loss at 68 weeks versus placebo. This is the primary efficacy dataset supporting the NDA filing.

Market reception of REDEFINE 1 at readout (December 2024) was mixed. While 22.7% represented the strongest weight loss reported for any Novo Nordisk compound, analysts had modeled higher figures ahead of the readout, and Novo Nordisk’s stock reacted sharply. Clinically, the result comfortably exceeds approved obesity benchmarks, but commercially it did not clear sky-high pre-readout expectations.

REDEFINE 4 — Head-to-Head vs. Tirzepatide

REDEFINE 4 was an 84-week open-label head-to-head trial (n=809) comparing CagriSema against tirzepatide 15 mg in adults with obesity and at least one comorbidity. Results were released February 23, 2026:

The 3.4 percentage-point gap on the treatment-regimen estimate exceeded the predefined non-inferiority margin. Both drugs produced clinically meaningful weight loss above 20%, but tirzepatide delivered greater efficacy in the only head-to-head comparison to date. For the full breakdown, see CagriSema vs Tirzepatide.

Safety & Tolerability

CagriSema’s safety profile is dominated by GLP-1-class gastrointestinal adverse events, layered with amylin-related tolerability signals. REDEFINE safety reporting indicates:

• Most common AEs: nausea, vomiting, diarrhea, constipation, decreased appetite — the standard GLP-1 class profile.
• Severity: Most GI AEs were mild to moderate and concentrated in the dose-escalation phase. Events tended to diminish over continued exposure.
• REDEFINE 4 comparison: Safety profiles were broadly comparable between CagriSema and tirzepatide, with GI events the most common in both arms.
• Discontinuation due to AEs: Low overall in REDEFINE 1 and REDEFINE 4. Exact per-dose discontinuation percentages are reported in Novo Nordisk’s trial disclosures.

No unexpected safety signals have been disclosed. Long-term tolerability, cardiovascular outcomes, and durability of effect are being assessed in ongoing trials.

How It Compares — CagriSema vs Retatrutide

The retatrutide profile compound (Eli Lilly) is a unimolecular triple agonist targeting GLP-1, GIP, and glucagon in a single engineered peptide. CagriSema is a co-formulation pairing two separate molecules that target GLP-1 and amylin. The two compounds represent opposite ends of the obesity-pipeline design spectrum.

On efficacy, retatrutide’s Phase 2 data at 48 weeks reported weight loss in the mid-twenties percent range, comparable to or exceeding CagriSema’s Phase 3 REDEFINE-1 figure of 22.7% at 68 weeks. Direct cross-trial comparisons are limited, but the glucagon + GIP arms in retatrutide appear to lift the ceiling beyond what GLP-1 + amylin achieves. Strategically, CagriSema is much closer to market — NDA already filed, FDA decision expected in late 2026 — while retatrutide is still working through the TRIUMPH Phase 3 programme. For a full three-way view, see Retatrutide vs Tirzepatide vs CagriSema.

May 2026 Updates: Device Pivot and ECO 2026 Body Composition

Two material updates landed in May 2026 that any current CagriSema profile needs to reflect.

1. Device pivot — single-chamber pen dropped, dual-pen launch confirmed. Novo Nordisk has abandoned the single-chamber co-formulated CagriSema pen and confirmed the product will launch as a dual-pen instead (two separate pens delivered together — cagrilintide alongside semaglutide — rather than one combined cartridge). Novo’s CEO publicly stated there is "no change" to the overall launch timeline, framing the decision as manufacturing and device-engineering rather than regulatory or clinical. Active ingredients, dosing, and the REDEFINE evidence base are unchanged. See Fierce Biotech coverage.

2. ECO 2026 REDEFINE-1 body composition — muscle-sparing weight loss. At the European Congress on Obesity in Türkiye (May 2026), a REDEFINE-1 sub-analysis presented a muscle-sparing weight loss profile for CagriSema. Lean-mass preservation relative to total weight loss is increasingly a focus across the GLP-1 class, and the readout is a partial-rehab data point after the REDEFINE-4 efficacy miss against tirzepatide — it doesn’t close the headline weight-loss gap, but it suggests body composition quality may be a differentiator worth tracking in future readouts. See the Pharmaceutical Technology analyst comment.

Research Use Notes

CagriSema as a finished co-formulation is not available through Remy Peptides. The component molecules — cagrilintide and semaglutide — are proprietary Novo Nordisk assets and are not distributed as research-grade reference standards through mainstream supply channels. Laboratories interested in GLP-1 + amylin pharmacology typically rely on the published REDEFINE literature, separate amylin-analog reference standards, and class-adjacent research peptides.

Remy Peptides supplies HPLC-verified retatrutide pens (Janoshik Analytical Batch RETP002, 99.262% purity) as its anchor next-generation obesity reference compound for in-vitro laboratory research. Retatrutide is the most advanced triple agonist in development and sits at the opposite end of the architecture spectrum from CagriSema, making it the logical reference for laboratories characterizing alternative obesity-drug mechanisms. For full laboratory context, see our retatrutide in Dubai research guide.

All Remy Peptides products are supplied for in-vitro laboratory research only. Not for human or veterinary use. UAE MoHAP Circular 17/2022 compliance statement.