TL;DR — What Is CagriSema?

CagriSema is Novo Nordisk’s once-weekly subcutaneous obesity candidate, pairing cagrilintide 2.4 mg (a long-acting amylin analog) and semaglutide 2.4 mg (the GLP-1 agonist also marketed as Wegovy). The Phase 3 REDEFINE programme reported approximately 22.7% weight loss at 68 weeks in REDEFINE-1 (efficacy estimand; −20.4% vs −3.0% with placebo under the treatment-policy estimand in the NEJM paper), while the peer-reviewed REIMAGINE 1–3 type 2 diabetes papers published June 2026 add a larger glycaemic-efficacy record. In REIMAGINE 2, CagriSema lowered HbA1c by 1.91 percentage points at 68 weeks versus 1.75 points with semaglutide 2.4 mg; Novo’s February disclosure reported 14.2% vs 10.2% body-weight change for the same comparison. REDEFINE-4 (Feb 2026, head-to-head vs tirzepatide 15 mg) produced 20.2% vs 23.6% at 84 weeks — non-inferiority was not met. In September 2026, REIMAGINE 5 (T2D) showed CagriSema 1.0/1.0 mg ahead of tirzepatide 5 mg on weight loss (12.4% vs 9.1%), and REDEFINE 9 showed 21.0% vs 2.0% placebo. Novo filed the NDA on December 18, 2025; Novo expects the FDA decision in Q4 2026 (no public PDUFA date). In May 2026, Novo ended its single-chamber co-formulation project; CagriSema is set to launch in a dual-chamber pen: one prefilled, single-dose autoinjector holding cagrilintide and semaglutide in separate chambers, with the CEO stating no change to the overall launch timeline. At its September 21, 2026 Capital Markets Day, Novo said a full launch is expected in early 2027, pending approval.

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:

The original plan was to deliver both peptides as a single-chamber co-formulation. In May 2026, Novo Nordisk ended that project; CagriSema is set to launch in a dual-chamber pen — one prefilled, single-dose autoinjector holding cagrilintide and semaglutide in separate chambers. 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:

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 October 12, 2026, the FDA decision is still pending; Novo restated on September 21, 2026 that it expects a decision in Q4 2026. No public PDUFA date has been confirmed. At its September 21, 2026 Capital Markets Day, Novo said a full launch is expected in early 2027, pending approval, and put the REDEFINE 11 readout in H1 2027 and the CagriSema HD readout in H1 2028. Novo’s R&D pipeline also lists a separate “CagriSema HD” obesity entry in Phase 3.

Trial Population Design Headline readout
REDEFINE-1 Adults with obesity 68 wk, placebo-controlled ~22.7% weight loss (efficacy estimand, Dec 2024 topline); −20.4% vs −3.0% placebo (treatment-policy, NEJM 2025); ECO 2026 sub-analysis showed muscle-sparing body composition (May 2026)
REDEFINE 2 Adults with obesity or overweight and type 2 diabetes 68 wk, placebo-controlled (n=1,206) −13.7% vs −3.4% with placebo (treatment-policy, NEJM 2025)
REIMAGINE 1–3 Type 2 diabetes Diet/exercise; vs semaglutide or cagrilintide; add-on to basal insulin Peer-reviewed June 2026 publications; REIMAGINE 2 showed HbA1c −1.91 points vs −1.75 with semaglutide 2.4 mg
REDEFINE-3 Adults aged 55+ with established cardiovascular disease and BMI ≥25 (7,101 enrolled per the registry; 7,076 randomised per the design paper) Event-driven, placebo-controlled cardiovascular outcomes (MACE) Active, not recruiting; primary completion estimated September 2027; no results yet (design paper, Am Heart J, October 2026)
REDEFINE-4 Obesity with comorbidities 84 wk, open-label, vs tirzepatide 15 mg (~809 participants) 20.2% vs 23.6% (treatment-regimen); 23.0% vs 25.5% (on-treatment); non-inferiority not met (Feb 23, 2026)
REIMAGINE 5 Type 2 diabetes 60 wk, CagriSema 1.0/1.0 mg vs tirzepatide 5 mg 12.4% vs 9.1% weight loss (superior); HbA1c −1.71% vs −1.67% (non-inferior) (Sept 21, 2026)
REDEFINE 9 Overweight or obesity 68 wk, CagriSema 1.0/1.0 mg vs placebo 21.0% vs 2.0% weight loss (Sept 21, 2026)

NDA timeline: Filed December 18, 2025. Novo expects the FDA decision in Q4 2026; no exact PDUFA date has been publicly confirmed. The filing pre-dates the REDEFINE-4 readout and rests on the placebo-controlled REDEFINE 1 and REDEFINE 2 trials, 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 22.7% mean weight loss at 68 weeks under the efficacy estimand (Novo’s December 2024 topline). The peer-reviewed NEJM paper (Garvey et al., 2025) reports −20.4% versus −3.0% with placebo under the treatment-policy estimand. With REDEFINE 2 in type 2 diabetes (−13.7% vs −3.4%), 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.

REIMAGINE 1–3 — Type 2 Diabetes Phase 3 Publications

On June 7, 2026, The Lancet and The Lancet Diabetes & Endocrinology published three Phase 3 CagriSema papers from Novo’s REIMAGINE programme. These papers matter because they move the type 2 diabetes evidence base from sponsor topline disclosure into peer-reviewed trial records. REIMAGINE 1 studied adults inadequately controlled on diet and exercise; REIMAGINE 2 compared CagriSema against semaglutide 2.4 mg, cagrilintide 2.4 mg, and placebo; REIMAGINE 3 tested add-on use with basal insulin. All endpoints below are trial-level research findings, not use guidance.

Trial Publication Population Headline trial finding
REIMAGINE 1 Lancet Diabetes & Endocrinology Type 2 diabetes inadequately controlled on diet and exercise At 40 weeks, CagriSema 2.4/2.4 mg changed HbA1c by −1.8 percentage points and body weight by −13.8% versus −0.1 points and −1.4% with placebo.
REIMAGINE 2 Lancet Diabetes & Endocrinology Type 2 diabetes; active comparator arms At 68 weeks, HbA1c changed −1.91 points with CagriSema versus −1.75 with semaglutide 2.4 mg. Novo’s topline disclosure reported body-weight change of −14.2% versus −10.2%.
REIMAGINE 3 The Lancet Type 2 diabetes using basal insulin At 40 weeks, HbA1c changed −2.33 points with CagriSema 2.4/2.4 mg and −2.10 with CagriSema 1.0/1.0 mg versus −0.66 with placebo; body-weight reductions were in the 10–12% range.

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:

Endpoint CagriSema Tirzepatide 15 mg
Weight loss (treatment-regimen) 20.2% 23.6%
Weight loss (on-treatment) 23.0% 25.5%
Non-inferiority met? No Comparator

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 15 mg delivered greater efficacy in REDEFINE 4. For the full breakdown, see CagriSema vs Tirzepatide.

REIMAGINE 5 and REDEFINE 9 — September 2026 Toplines

On September 21, 2026, Novo reported two more Phase 3 toplines, both using the lower CagriSema 1.0 mg/1.0 mg dose. REIMAGINE 5 was a second head-to-head against tirzepatide, this time in adults with type 2 diabetes and against tirzepatide 5 mg: CagriSema produced 12.4% weight loss versus 9.1% at week 60 (superior), with a non-inferior HbA1c reduction (1.71% vs 1.67%). REDEFINE 9 in adults with overweight or obesity showed 21.0% weight loss versus 2.0% for placebo at week 68. Novo reported both figures on the efficacy estimand and said CagriSema remains investigational, with an FDA decision expected in Q4 2026. See the Novo release.

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:

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 fixed-dose combination 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 now has Phase 3 data: in TRIUMPH-1 (NEJM, September 29, 2026), the 12 mg dose produced 25.0% weight loss at 80 weeks on the treatment-regimen estimand (Lilly’s efficacy-estimand topline was 28.3%), versus CagriSema’s Phase 3 REDEFINE-1 figures of 20.4% (treatment-policy) and 22.7% (efficacy estimand) 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 closer to market — NDA already filed, FDA decision expected in Q4 2026 — while Lilly says it will file for US approval no later than Q1 2027 after the TRIUMPH Phase 3 readouts (Lilly, July 23, 2026). Neither is approved. 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 co-formulation dropped, dual-chamber pen confirmed. Novo Nordisk ended its single-chamber co-formulation project, citing portfolio considerations (disclosed with its Q1 2026 results on May 6, 2026). The fixed-dose combination is set to be delivered in a dual-chamber pen — one prefilled, single-dose autoinjector that holds cagrilintide and semaglutide in separate chambers; a usability study of the CagriSema dual-chamber pen was published in June 2026. Novo’s CEO publicly stated there is "no change" to the overall launch timeline. 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 product is not available through Remy Research, and Remy Research does not sell semaglutide. Cagrilintide is sold only within the Genovare RETAKLIK 2.0 retatrutide + cagrilintide research pen (independent COA pending). 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 Research sells retatrutide research pens for in-vitro laboratory research; the published Janoshik Analytical report for the Remedium Research 30mg FlexiPen is batch RETP002 (99.262% HPLC purity). 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 Dubai research guide.

All Remy Research products are supplied for in-vitro laboratory research only. Not for human or veterinary use.

CagriSema is Novo Nordisk’s once-weekly subcutaneous obesity candidate pairing two peptides: cagrilintide 2.4 mg, a long-acting amylin analog, and semaglutide 2.4 mg, the GLP-1 receptor agonist also marketed as Wegovy. The original plan was a single-chamber co-formulation; Novo ended that project in May 2026, and CagriSema is set to launch in a dual-chamber pen: one prefilled, single-dose autoinjector holding cagrilintide and semaglutide in separate chambers. Active ingredients, dosing, and the REDEFINE evidence are unchanged.
No. Novo Nordisk filed the CagriSema NDA on December 18, 2025. As of October 12, 2026, the FDA decision is still pending; Novo restated on September 21, 2026 that it expects a decision in Q4 2026 and a full launch in early 2027, pending approval. No public PDUFA date has been confirmed. CagriSema is not yet approved in the United States or any other major regulatory territory.
Yes. In May 2026, Novo Nordisk ended its single-chamber co-formulation project. CagriSema is set to launch in a dual-chamber pen: one prefilled, single-dose autoinjector holding cagrilintide and semaglutide in separate chambers. Novo’s CEO stated there is no change to the overall launch timeline. Active ingredients, dosing, and REDEFINE evidence are unchanged.
In REDEFINE 1, the pivotal Phase 3 placebo-controlled trial, CagriSema produced approximately 22.7% weight loss at 68 weeks in adults with obesity under the efficacy estimand (−20.4% vs −3.0% with placebo under the treatment-policy estimand, NEJM 2025). In REDEFINE 4, the head-to-head comparison with tirzepatide 15 mg, CagriSema produced 20.2% weight loss at 84 weeks (treatment-regimen estimate) versus 23.6% for tirzepatide. In REDEFINE 9 (September 2026), the lower CagriSema 1.0/1.0 mg dose produced 21.0% weight loss versus 2.0% for placebo at week 68.
CagriSema pairs two separate peptides delivered once weekly. Semaglutide activates the GLP-1 receptor, suppressing appetite and slowing gastric emptying. Cagrilintide activates the amylin and calcitonin receptors, reinforcing satiety through a brainstem-mediated pathway distinct from GLP-1. The combination hypothesis is that dual amylin + GLP-1 agonism produces additive weight loss beyond either component alone. (After Novo’s May 2026 device change, the two peptides are set to be delivered from a dual-chamber pen rather than as a single-chamber co-formulation.)
Not at the highest doses. In REDEFINE 4, CagriSema failed to demonstrate non-inferiority to tirzepatide 15 mg. CagriSema produced 20.2% weight loss versus 23.6% for tirzepatide at 84 weeks (treatment-regimen estimate), a 3.4 percentage-point gap that exceeded the predefined non-inferiority margin. Both drugs produced clinically meaningful weight loss exceeding 20%. In a second head-to-head trial, REIMAGINE 5 (September 2026, type 2 diabetes), CagriSema 1.0/1.0 mg showed superior weight loss versus tirzepatide 5 mg (12.4% vs 9.1% at week 60) with a non-inferior HbA1c reduction.
CagriSema and retatrutide take opposite architectural approaches. CagriSema is a fixed-dose combination of two molecules (cagrilintide + semaglutide) combining GLP-1 and amylin pathways. Retatrutide is a single unimolecular triple agonist targeting GLP-1, GIP, and glucagon. In the Phase 3 TRIUMPH-1 trial (NEJM, September 2026), retatrutide 12 mg produced 25.0% weight loss at 80 weeks (treatment-regimen estimand; Lilly’s efficacy-estimand topline was 28.3%), above CagriSema’s Phase 3 numbers in cross-trial terms. CagriSema is closer to approval (FDA decision expected Q4 2026); Lilly says it will file for US approval no later than Q1 2027, and neither is approved.
CagriSema as a finished product is not available through Remy Research, and Remy Research does not sell semaglutide. Cagrilintide is sold only within the Genovare RETAKLIK 2.0 retatrutide + cagrilintide research pen, which has no independent COA yet. Remy Research also sells retatrutide research pens for in-vitro laboratory research.

Our Research Standards

This article cites peer-reviewed studies, FDA filings, and ClinicalTrials.gov data. All claims are cross-referenced against primary sources. We update articles when new trial data or regulatory decisions are published. Read our editorial policy →

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Editorial Board, Remy Research

The Remy Research Editorial Board reviews research articles covering GLP-1 receptor agonists, triple agonists, and the obesity drug pipeline. Its review spans peptide analytical chemistry, HPLC purity validation, and clinical trial data interpretation.

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References & Citations
  1. Novo Nordisk. CagriSema demonstrates superior weight loss in adults with obesity or overweight in the REDEFINE 1 trial (22.7% at 68 weeks, trial product estimand). December 20, 2024. novonordisk.com
  2. GlobeNewswire. Novo Nordisk A/S: CagriSema demonstrated 23% weight loss in an open-label head-to-head REDEFINE 4 trial in people with obesity — primary endpoint was not achieved. February 23, 2026. globenewswire.com
  3. Novo Nordisk. CagriSema demonstrated superior HbA1c reduction (1.91 points) and 14.2% weight loss vs semaglutide in adults with type 2 diabetes (REIMAGINE programme). February 2026. novonordisk.com
  4. Aroda VR, et al. Efficacy and safety of once-weekly cagrilintide-semaglutide (CagriSema) in adults with type 2 diabetes inadequately controlled on diet and exercise (REIMAGINE 1): a randomised, double-blind, placebo-controlled, phase 3a study. Lancet Diabetes Endocrinol. 2026 Jun 7. PMID 42251860. pubmed.ncbi.nlm.nih.gov
  5. Buse JB, et al. Cagrilintide-semaglutide (CagriSema) versus semaglutide or cagrilintide in people with type 2 diabetes (REIMAGINE 2): a double-blind, randomised, controlled, phase 3 study. Lancet Diabetes Endocrinol. 2026 Jun 7. PMID 42251859. pubmed.ncbi.nlm.nih.gov
  6. Rosenstock J, et al. Cagrilintide-semaglutide (CagriSema) as an add-on to basal insulin in adults with type 2 diabetes (REIMAGINE 3): a randomised, double-blind, placebo-controlled, multicentre, phase 3 study. The Lancet. 2026 Jun 7. PMID 42251856. pubmed.ncbi.nlm.nih.gov
  7. Fierce Biotech. Novo CEO insists ‘no change in plan’ for CagriSema launch after single-chamber device ditched. May 2026. fiercebiotech.com
  8. Pharmaceutical Technology. ECO 2026 — REDEFINE-1 CagriSema body composition analysis (Türkiye). May 2026. pharmaceutical-technology.com
  9. ClinicalTrials.gov. REDEFINE 4: A Trial Comparing the Effect of CagriSema With Tirzepatide in People Living With Overweight or Obesity (NCT06131437). clinicaltrials.gov
  10. Novo Nordisk. Novo Nordisk files for FDA approval of CagriSema, the first once-weekly combination of GLP-1 and amylin analogues for weight management. December 18, 2025. novonordisk.com
  11. Novo Nordisk. CagriSema (cagrilintide + semaglutide) pipeline overview. novonordisk.com
  12. Novo Nordisk. Novo’s CagriSema delivers superior weight loss versus tirzepatide in REIMAGINE 5 trial (REIMAGINE 5 and REDEFINE 9 toplines; decision expected Q4 2026). September 21, 2026. globenewswire.com
  13. Jastreboff AM, et al. Retatrutide, a Triple Hormone Receptor Agonist, for Treatment of Obesity (TRIUMPH-1). N Engl J Med. Published September 29, 2026. doi:10.1056/NEJMoa2604169. nejm.org
  14. Eli Lilly. Lilly’s triple agonist retatrutide successful in two additional Phase 3 trials; BLA submission planned Q1 2027. July 23, 2026. lilly.com
  15. Garvey WT, et al. Coadministered Cagrilintide and Semaglutide in Adults with Overweight or Obesity (REDEFINE 1). N Engl J Med. 2025;393(7):635-647. PMID 40544433. pubmed.ncbi.nlm.nih.gov
  16. Davies MJ, et al. Cagrilintide-Semaglutide in Adults with Overweight or Obesity and Type 2 Diabetes (REDEFINE 2). N Engl J Med. 2025;393(7):648-659. PMID 40544432. pubmed.ncbi.nlm.nih.gov
  17. Cavender MA, et al. Design and baseline characteristics of the CagriSema cardiovascular outcomes trial (REDEFINE 3). Am Heart J. 2026 Oct 6. PMID 42838477. pubmed.ncbi.nlm.nih.gov
  18. Gulisano W, et al. Ease of Use, Ease of Learning, and Convenience of the CagriSema Dual-Chamber Pen: Results From a Usability Study. J Diabetes Sci Technol. 2026 Jun 28. PMID 42366647. pubmed.ncbi.nlm.nih.gov
  19. Novo Nordisk. Capital Markets Day 2026 — US Operations presentation (CagriSema: pending decision, full launch expected during start of 2027; REDEFINE 11 and CagriSema HD readouts H1 2027 and H1 2028). September 21, 2026. novonordisk.com
  20. Eli Lilly. Lilly’s EloraTZP (combination of eloralintide and tirzepatide) delivered greater weight loss and A1C reduction vs. tirzepatide 15 mg in adults with obesity and type 2 diabetes. September 30, 2026. investor.lilly.com
  21. Zealand Pharma. Positive Phase 2 ZUPREME-2 topline results for petrelintide; Phase 3 programme started. October 7, 2026. globenewswire.com