A New Combination Therapy Hits the Mark

Progress keeps coming in the pharmacotherapy for obesity. This week, Novo Nordisk announced that its new combination therapy of semaglutide and cagrilintide hit all its marks in a 32-week phase 2 study of patients with diabetes and excess weight. The combination – Novo is calling it CagriSema – worked better than either semaglutide or cagrilintide alone. This was true both for its effect on HbA1c and its effect on body weight.

Notably, in these patients with an average weight of 106 kg, the average weight loss was 16 percent. For reference, the loss with semaglutide alone was 5 percent in this patient population. In a different 40-week study of tirzepatide in patients with diabetes and excess weight, the weight loss ranged from 9 to 13 percent, depending upon the dose.

So, indeed, these results are impressive.

Still Early, but “Eagerly Awaited”

Let’s be clear, these still early days for CagriSema. Phase 2 studies serve to give the first reading on whether a new drug really works for its intended purpose. This study was targeting diabetes, not obesity. So it’s giving us only a hint of how it might work in patients with obesity and not diabetes.

Novo Nordisk plans to start phase 3 trials for CagriSema in obesity late this year – actually before the phase 3 trials in diabetes commence next year.

It’s important to remember that weight loss from these types of drugs in persons with diabetes and obesity tends to be less than it is in persons with obesity alone. For example, whereas weight loss with terzepatide maxed out at 13 percent for persons with both conditions, it reached more than 20 percent in persons with obesity alone.

So the notion that this new combination therapy might even exceed that milestone is genuinely exciting. We have much yet to learn. But as  Sara Becerril and Gema Frühbeck wrote in Lancet a year ago, the prospect of a more effective combination therapy for obesity is “eagerly awaited.”

Click here and here for more on the news of these phase 2 results. For the commentary by Becerril and Frühbeck, click here.

Synergy, photograph by Alf van Beem, provided through CC0 1.0 public domain dedication

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August x, 2022