Novo Nordisk says CagriSema beat semaglutide on blood sugar and weight in diabetes trial
A combination of semaglutide and cagrilintide outperformed semaglutide alone in a phase 3 diabetes trial, though the drug is not yet approved and a filing for weight management is already with the FDA.
CagriSema, an experimental once-weekly injection that pairs semaglutide with the amylin-based drug cagrilintide, lowered blood sugar and body weight by more than semaglutide alone in adults with type 2 diabetes, Novo Nordisk said on February 2, 2026 [1][2]. The results come from REIMAGINE 2, a phase 3 trial, and the company said it will now approach regulators to discuss a path to approval in diabetes [1][2].
What the trial measured
REIMAGINE 2 enrolled 2,728 adults whose type 2 diabetes was not adequately controlled with metformin, with or without an SGLT2 inhibitor; about 40% were already taking an SGLT2 inhibitor when they entered the trial [1][2]. Participants were assigned to one of two CagriSema dose combinations (2.4 mg cagrilintide plus 2.4 mg semaglutide, or 1.0 mg plus 1.0 mg), semaglutide alone at 2.4 mg or 1.0 mg, cagrilintide 2.4 mg alone, or placebo, all given once weekly under the skin for 68 weeks [1][2].
Starting from an average HbA1c of 8.2%, people on CagriSema 2.4 mg/2.4 mg saw an average drop of 1.91 percentage points, compared with 1.76 points on semaglutide 2.4 mg and a rise of 0.09 points on placebo [1][2]. Starting from an average weight of 101 kg (about 223 pounds), weight fell 14.2% with CagriSema versus 10.2% with semaglutide 2.4 mg and 1.5% with placebo [1][2]. Novo Nordisk reported that weight loss had not plateaued at week 68 [1][2].
At the higher CagriSema dose, 43% of participants lost at least 15% of their body weight and 24% lost at least 20% [1][2]. Novo Nordisk said superiority was established across all tested doses in the trial and against each of the individual components; specific figures were disclosed only for the 2.4 mg/2.4 mg dose against semaglutide 2.4 mg [1][2].
Under a second analysis that counts everyone assigned to treatment regardless of whether they stayed on it, HbA1c fell 1.80 points with CagriSema 2.4 mg/2.4 mg versus 1.68 points with semaglutide 2.4 mg, and weight fell 12.9% versus 9.2% [1][2].
Novo Nordisk said CagriSema "appeared to have a safe and well-tolerated profile consistent with incretin and amylin-based therapies," with gastrointestinal side effects the most common, the vast majority mild to moderate and diminishing over time [1][2]. Discontinuation rates and full side-effect tables were not included in the announcement and have not been reported [1][2].
"We are very pleased by the clinical profile of CagriSema in type 2 diabetes patients," said Martin Holst Lange, Novo Nordisk's chief scientific officer and head of research and development [1][2].
Why it matters for patients
CagriSema is not a new molecule so much as a combination: it adds cagrilintide, an amylin-based drug, to semaglutide, the active ingredient in Ozempic and Wegovy [1][2]. It is given as a single once-weekly injection, not a pill, and it has not been approved by the FDA [1][2].
The two drugs differed far more on weight than on blood sugar. The 14.2% versus 10.2% weight result is a gap of about four percentage points, while the HbA1c gap was 0.15 points [1][2]. For someone whose main concern is glucose control, the added benefit over semaglutide in this trial was modest; for someone also trying to lose weight, the difference was larger [1][2].
Because the trial compared CagriSema with semaglutide and cagrilintide separately, it speaks to whether combining the two adds anything [1][2]. It did not compare CagriSema with tirzepatide, the active ingredient in Mounjaro and Zepbound; those head-to-head studies are still running [1][2]. Pricing, insurance coverage and launch timing have not been disclosed [1][2].
What happens next
- Novo Nordisk said it will approach authorities to discuss the regulatory pathway for CagriSema in type 2 diabetes, after the results of REIMAGINE 1 and REDEFINE 3 [1][2]. No date for those discussions was given.
- Detailed REIMAGINE 2 results will be presented at a scientific conference in 2026; the company did not name the meeting or a date [1][2].
- CagriSema for weight management was submitted to the FDA in December 2025 based on the REDEFINE 1 and REDEFINE 2 trials [1][2]. A decision date has not been disclosed.
- REIMAGINE 4 (CagriSema 2.4 mg/2.4 mg versus tirzepatide 15 mg in 1,000 adults, 68 weeks) and REIMAGINE 5 (CagriSema 1.0 mg/1.0 mg versus tirzepatide 5 mg in 1,000 adults, 68 weeks) have not reported results [1][2]. REDEFINE 3, a cardiovascular outcomes trial in 7,000 adults with established cardiovascular disease and overweight or obesity, is also ongoing [1][2].
Sources
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