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Combination Therapy — Amylin Analog + GLP-1 Agonist

CagriSema Phase III

Cagrilintide + Semaglutide  |  Novo Nordisk fixed-dose combo  |  NN9838 + semaglutide  |  REDEFINE pipeline
Class
Amylin + GLP-1 combination
Components
Cagrilintide 2.4 mg + Semaglutide 2.4 mg
Route
SubQ once weekly
Phase 3 REDEFINE 1
−20.4% @ 68 wk (non-DM)
Phase 3 REDEFINE 2
−13.7% @ 68 wk (T2D)
FDA Status
Under review
Developer
Novo Nordisk
Trials
REDEFINE 1/2 complete; CVOT ongoing
WADA Status
Not specifically listed
Cost & Access
Research-only (pending approval)
TL;DR

20.4% weight loss in Phase 3. Novo's combo to beat tirzepatide.
What is it? Novo Nordisk's once-weekly subcutaneous fixed-dose combo of cagrilintide (amylin analog, 2.4 mg) and semaglutide (GLP-1 agonist, 2.4 mg) in a single injection.
What does it do? Hits two appetite circuits: semaglutide engages hypothalamic and brainstem GLP-1 receptors; cagrilintide engages amylin/calcitonin receptors in the area postrema. Together they cut appetite and slow gastric emptying more than either alone.
Does the evidence hold up? REDEFINE-1 (NEJM 2025, 3,417 non-diabetic adults) cut weight 20.4% at 68 weeks vs 3.0% placebo. REDEFINE-2 (1,206 T2D adults) cut 13.7% vs 3.4%. Both published June 2025.
Who uses it? Under FDA review. Not yet approved. Gray-market combinations of separate cagrilintide and semaglutide vials already exist, usually at lower doses than the Phase 3 formulation.
Bottom line? Novo's answer to Zepbound. The REDEFINE trials already beat semaglutide alone. Approval is the missing piece.

What It Is

CagriSema is an investigational fixed-dose once-weekly subcutaneous combination anti-obesity drug developed by Novo Nordisk, pairing two peptides in a single injection: cagrilintide 2.4 mg (a long-acting lipidated analog of the pancreatic hormone amylin, code AM833 / NN9838) and semaglutide 2.4 mg (a GLP-1 receptor agonist already approved and marketed under the brand names Ozempic, Wegovy, and Rybelsus). The "CagriSema" portmanteau refers to this fixed-dose pairing — the two components are separately well-characterized peptides being jointly advanced for obesity as a single commercial product.

The rationale for combining the two is mechanistic. Native amylin and GLP-1 are both meal-related satiety hormones, but they act at different receptors expressed on different populations of CNS neurons. GLP-1 receptors are densely expressed in the hypothalamic arcuate nucleus, the nucleus of the solitary tract (NTS), and the area postrema. Amylin receptors (calcitonin-receptor + RAMP complexes forming AMY1R, AMY2R, AMY3R) are most densely expressed in the area postrema and the NTS, with distinct downstream circuits. Because the two signaling systems converge on appetite regulation through substantially non-overlapping wiring, combining them offered the possibility of additive — not merely incremental — weight loss.

Phase 1b data (Enebo 2021) confirmed the hypothesis in short-term dosing. The REDEFINE Phase 3 program scaled the trial into pivotal non-diabetic obesity (REDEFINE 1) and obesity + type 2 diabetes (REDEFINE 2) populations. The headline REDEFINE 1 result — 20.4% mean weight loss at 68 weeks in 3,417 non-diabetic adults — was published in NEJM in June 2025 and places CagriSema roughly at parity with tirzepatide (SURMOUNT-1, −20.9%). REDEFINE 2 in T2D produced a smaller but still clinically meaningful 13.7% weight loss plus HbA1c improvement.

As of April 2026, CagriSema is under FDA review. A cardiovascular outcomes trial (REDEFINE-CVOT) is underway but not required for the primary approval pathway. If approved, CagriSema would be the first fixed-dose amylin + GLP-1 combination product — the leading second-market-entry to the dual-agonist / combination obesity drug landscape established by tirzepatide. Its commercial positioning would target the upper-tier of obesity magnitude, competing directly with tirzepatide on weight loss and with retatrutide (once that triple-agonist matures through its own Phase 3 program).

Mechanism of Action

CagriSema's mechanism is the additive combination of two well-characterized parent mechanisms. Neither component is novel in isolation; the combination's novelty is the additivity demonstrated across Phase 1b / Phase 2 / Phase 3 readouts.

What the Research Shows

CagriSema has one of the largest Phase 3 datasets of any obesity combination product, with two pivotal trials plus a cardiovascular outcomes trial underway.

Honest Evidence Framing

CagriSema's Phase 3 program is well-powered and convincingly positive. The most important caveats are: (1) long-term safety beyond ~2 years remains to be demonstrated (REDEFINE-CVOT will address this); (2) durability of weight loss after discontinuation is expected to follow the class pattern — rapid partial regain, consistent with STEP-4 semaglutide data; (3) GI adverse events were common (~80%) and are the rate-limiting tolerability factor during titration; (4) the head-to-head data against tirzepatide does not yet exist, and head-to-head against retatrutide won't exist for years.

Human Data

CagriSema's human dataset is extensive and focused on the combination formulation specifically:

Dosing from the Literature

CagriSema dosing is defined by the Phase 3 program: both components escalated in parallel to 2.4 mg each, once weekly.

ProtocolDoseFrequencyNotes
REDEFINE target doseCagrilintide 2.4 mg + semaglutide 2.4 mgOnce weekly SubQSingle injection (fixed-dose) or paired separate injections in DIY combination.
Titration (REDEFINE protocol)0.25 → 0.5 → 1.0 → 1.7 → 2.4 mg (each component)Weekly escalation over 16 weeksParallel titration of both components; GI tolerability is rate-limiting.
Monotherapy baseline (for reference)Semaglutide 2.4 mg aloneOnce weekly SubQBenchmark comparator in Phase 3 programs.
DIY concurrent dosing (gray-market)Two separate weekly injections matching fixed-dose targetWeekly, same dayUsed by early adopters ahead of fixed-dose approval; not equivalent to an approved combination product.
CycleContinuous maintenanceNot intended for intermittent use; weight regain expected on discontinuation.
Dosing Disclaimer

CagriSema is investigational. There is no FDA-approved human dose. The 2.4 mg + 2.4 mg target is from the Phase 3 program. Compressing titration dramatically worsens GI tolerability without improving the final endpoint. Self-administration of research-grade components is regulated in most jurisdictions. Consult a licensed clinician.

Reconstitution & Storage

The approved commercial CagriSema (once FDA-approved) is expected to be delivered as a pre-filled autoinjector similar to Wegovy or Ozempic. Research-chemical versions of the separate components are supplied as lyophilized powders that require reconstitution.

ComponentVial / BACConcentration2.4 mg Dose Volume
Cagrilintide 5 mg2 mL BAC2.5 mg/mL0.96 mL (~96 units)
Cagrilintide 10 mg2 mL BAC5 mg/mL0.48 mL (~48 units)
Semaglutide 5 mg2 mL BAC2.5 mg/mL0.96 mL (~96 units)
Semaglutide 10 mg2 mL BAC5 mg/mL0.48 mL (~48 units)

→ Use the Kalios Dosing Calculator for component volumes

Side Effects & Risks

Important

CagriSema combines two hormonal peptides. Expect GLP-1-class GI effects, a potential gallbladder and pancreatitis signal, and gastroparesis risk. Talk to someone licensed before mimicking any trial dose on gray-market vials.

CagriSema's safety profile inherits from both parent components; the Phase 3 program demonstrates the combined profile.

Quick Compare — CagriSema vs Tirzepatide vs Semaglutide vs Retatrutide

CagriSema enters a competitive late-stage obesity-drug landscape with several near-term and mid-term rivals. The key comparators are tirzepatide (approved dual GIP/GLP-1), semaglutide (approved GLP-1, one of the components of CagriSema), and retatrutide (investigational triple GIP/GLP-1/glucagon agonist).

FeatureCagriSemaTirzepatideSemaglutideRetatrutide
ClassAmylin + GLP-1GIP + GLP-1GLP-1GIP + GLP-1 + glucagon
Route / cadenceSubQ weeklySubQ weeklySubQ weekly / oral dailySubQ weekly
Pivotal weight loss (non-DM)−20.4% @ 68 wk (REDEFINE 1)−20.9% @ 72 wk (SURMOUNT-1)−14.9% @ 68 wk (STEP-1)−24.2% @ 48 wk (Phase 2)
Pivotal weight loss (T2D)−13.7% @ 68 wk (REDEFINE 2)SURPASS dataSUSTAIN dataTRIUMPH program
Approval statusUnder FDA reviewApproved (Zepbound / Mounjaro)Approved (Wegovy / Ozempic / Rybelsus)Phase 3 ongoing
CV outcomesREDEFINE-CVOT ongoingSURPASS-CVOT ongoingSELECT positive (20% MACE reduction)TRIUMPH program
Oral optionNone expectedNoneRybelsus (oral semaglutide)None currently
Once-monthly optionNoneNoneNone approvedNone
Unique featureFirst amylin + GLP-1 comboGIPR component blunts nausea, increases adipose sensitivityLongest approved CV outcomes recordGCGR component drives liver-fat and energy-expenditure

Practical interpretation:

→ See Cagrilintide profile  •  → See Semaglutide profile  •  → See Tirzepatide profile  •  → See Retatrutide profile

Bloodwork & Monitoring

Commonly Stacked With

The two components of CagriSema. The fixed-dose combination is the approved-pathway version; DIY concurrent dosing of the separate components is the gray-market equivalent ahead of approval.

Added for lean-mass preservation during rapid weight loss (FDA-approved for HIV lipodystrophy; mechanism-independent from the incretin axis). Practitioner-level stacking for body-composition-focused protocols.

GH-axis support during rapid weight loss. Not clinically validated in combination; commonly layered in practitioner protocols.

GI mucosal protection during high-GI-burden incretin therapy. Mechanistically complementary; not clinically validated.

Protein + creatine + resistance training

The non-peptide adjuncts with the highest leverage for lean-mass preservation during rapid caloric deficit.

→ Check compound compatibility in the Stack Builder

Regulatory Status

Current Status — April 2026

CagriSema is under FDA review following Phase 3 readouts from REDEFINE 1 (non-diabetic obesity, NCT05567796) and REDEFINE 2 (obesity + T2D, NCT05394519), published simultaneously in the New England Journal of Medicine in June 2025. Regulatory decision is anticipated within 1–2 years.

Novo Nordisk has signaled intent to pursue U.S. and EU approval on the weight-management indication first, with T2D potentially following. A cardiovascular outcomes trial (REDEFINE-CVOT) is ongoing but is not gating the primary weight-management approval pathway.

CagriSema is not on the FDA Category 2 Bulk Drug Substances list. Once approved, compounded CagriSema will face the same 503A/503B enforcement posture as compounded semaglutide and tirzepatide — compounding from bulk is disfavored when an approved drug exists.

CagriSema is not specifically listed on the WADA Prohibited List, though athletes should consult their sport-specific federation given S4 (hormone and metabolic modulators) umbrella considerations.

Semaglutide (component) is FDA-approved; cagrilintide (component) is investigational. The fixed-dose combination is not yet approved in any market as of April 2026.

Cost & Access

CagriSema is not approved for human use. It is available only as a pairing of research-grade cagrilintide + research-grade or compounded semaglutide, purchased separately from research suppliers for laboratory research purposes. No U.S. compounding pharmacy can legally compound cagrilintide — it has no FDA-approved reference product.

Community DIY combination protocols involve reconstituting separate cagrilintide and semaglutide vials and injecting them either as two separate injections or as one combined draw on the same day. This is not equivalent to the approved CagriSema product: dose accuracy depends on research-vendor potency, and the mass and per-mg per-volume details must be calculated separately.

Once FDA-approved, commercial CagriSema is expected to be priced within the modern obesity drug range and covered by the same payer patchwork as Wegovy / Zepbound — with patient-assistance programs, employer-sponsored coverage, and cash-pay options varying widely. Medicare coverage of obesity drugs remains limited as of April 2026.

CagriSema is not among the peptides under HHS Secretary Robert F. Kennedy Jr.'s February 2026 Category 2 reclassification announcement. Its regulatory pathway is standard FDA approval, not compounding reclassification.

Access and availability information as of April 2026. Kalios does not sell compounds.

Related Compounds

People researching CagriSema often also look at these:

Dual GIP/GLP-1 receptor agonist (Mounjaro / Zepbound). Superior weight-loss and glycemic efficacy vs semaglutide.

Selective long-acting amylin-receptor agonist in Phase II for obesity.

Triple GLP-1 / GIP / glucagon agonist. The most potent obesity drug in Phase III, ~24% body weight reduction.

Synthetic amylin analogue (Symlin). Post-prandial glucose and satiety modulator.

Next Steps

Key References

  1. Garvey WT, Frias JP, Jastreboff AM, et al. Coadministered Cagrilintide and Semaglutide in Adults with Overweight or Obesity (REDEFINE 1). N Engl J Med. 2025. DOI: 10.1056/NEJMoa2502081.
  2. Davies MJ, Frias JP, Jastreboff AM, et al. Cagrilintide-Semaglutide in Adults with Overweight or Obesity and Type 2 Diabetes (REDEFINE 2). N Engl J Med. 2025. PMID: 40544432. DOI: 10.1056/NEJMoa2502082.
  3. Enebo LB, Berthelsen KK, Kankam M, et al. Safety, tolerability, pharmacokinetics, and pharmacodynamics of concomitant administration of multiple doses of cagrilintide with semaglutide 2·4 mg for weight management: a randomised, controlled, phase 1b trial. Lancet. 2021;397(10286):1736-1748. PMID: 33894838.
  4. Frias JP, Deenadayalan S, Erichsen L, et al. Efficacy and safety of co-administered once-weekly cagrilintide 2·4 mg with once-weekly semaglutide 2·4 mg in type 2 diabetes: a multicentre, randomised, double-blind, active-controlled, phase 2 trial. Lancet. 2023;402(10403):720-730.
  5. Lau DCW, Erichsen L, Francisco AM, et al. Once-weekly cagrilintide for weight management in people with overweight and obesity: a multicentre, randomised, double-blind, placebo-controlled and active-controlled, dose-finding phase 2 trial. Lancet. 2021;398(10317):2160-2172.
  6. Kruse T, Dahl K, Frigeri P, et al. AM833 Is a Novel Agonist of Calcitonin Family G Protein-Coupled Receptors. Endocrinology. 2021;162(6):bqab057. PMID: 33727283.
  7. Kruse T, Hansen JL, Dahl K, et al. Development of Cagrilintide, a Long-Acting Amylin Analogue. J Med Chem. 2021;64(15):11183-11194.
  8. Wilding JPH, Batterham RL, Calanna S, et al. Once-Weekly Semaglutide in Adults with Overweight or Obesity (STEP-1). N Engl J Med. 2021;384(11):989-1002. PMID: 33567185. (Semaglutide-alone comparator.)
  9. Jastreboff AM, Aronne LJ, Ahmad NN, et al. Tirzepatide Once Weekly for the Treatment of Obesity (SURMOUNT-1). N Engl J Med. 2022;387(3):205-216. PMID: 35658024. (Competing dual-agonist.)
  10. Jastreboff AM, Kaplan LM, Frías JP, et al. Triple-Hormone-Receptor Agonist Retatrutide for Obesity — A Phase 2 Trial. N Engl J Med. 2023;389(6):514-526. PMID: 37366315. (Competing triple-agonist.)
  11. Lincoff AM, Brown-Frandsen K, Colhoun HM, et al. Semaglutide and Cardiovascular Outcomes in Obesity without Diabetes (SELECT). N Engl J Med. 2023;389(24):2221-2232. PMID: 37952131. (Semaglutide CV benchmark.)
  12. Hay DL, Garelja ML, Poyner DR, Walker CS. Update on the pharmacology of calcitonin/CGRP family of peptides: IUPHAR Review 25. Br J Pharmacol. 2018;175(1):3-17. PMID: 29059473.
  13. Novo Nordisk. REDEFINE 1 press release and investor presentation, June 2025.
  14. ClinicalTrials.gov. REDEFINE 1: NCT05567796. REDEFINE 2: NCT05394519. REDEFINE-CVOT: Novo Nordisk cardiovascular outcomes trial.
  15. Amycretin (NNC0487-0111), a novel, unimolecular GLP-1 and amylin receptor agonist administered subcutaneously: results from a phase 1b/2a randomised controlled study. Lancet. 2025. (Successor single-molecule program.)

Last updated: April 2026  |  Profile authored by Kalios Peptides research team