Cagrilintide

Cagrilintide is a long-acting amylin analog developed by Novo Nordisk as a next-generation obesity treatment. Amylin is a naturally occurring hormone co-secreted with insulin from pancreatic beta cells that regulates satiety and gastric emptying. Cagrilintide is a stabilized, long-acting version (half-life ~7 days) that provides sustained amylin receptor activation. It works through multiple complementary mechanisms: slows gastric emptying to prolong fullness, activates satiety centers in the brainstem (area postrema), reduces food intake by enhancing meal-induced satiety, and suppresses glucagon secretion to improve glucose control. The peptide has shown remarkable efficacy in clinical trials, particularly when combined with semaglutide (GLP-1 agonist) in the CagriSema formulation. The REDEFINE trials demonstrated that cagrilintide + semaglutide produced up to 17.1% body weight loss over 32 weeks - significantly superior to semaglutide alone (9.8%). Cagrilintide addresses a different pathway than GLP-1 agonists, making the combination synergistic rather than redundant. Monotherapy studies show cagrilintide alone produces 6-10% weight loss. The peptide is administered via weekly subcutaneous injection and has an improved side effect profile compared to earlier amylin analogs like pramlintide, with less nausea and GI distress. Currently in Phase 3 trials with expected FDA submission for CagriSema combination therapy.

Cagrilintide requires slow titration to minimize gastrointestinal side effects. Clinical trial protocol: Start at 0.3mg weekly for 4 weeks, increase to 0.6mg for 4 weeks, then 1.2mg for 4 weeks, then 1.8mg for 4 weeks, and finally 2.4mg maintenance dose. Each dose increase should be made only if the previous dose is well-tolerated. If combining with semaglutide (CagriSema), both peptides are titrated simultaneously but may require slower escalation. Administer on the same day each week, with or without food. Injection sites: abdomen, thigh, or upper arm - rotate sites to prevent lipohypertrophy. If a dose is missed and it's been less than 5 days since scheduled dose, take immediately. If more than 5 days, skip and resume normal schedule.