Cagrilintide With Semaglutide: A Way to Prevent Diabesity?

SAN DIEGO — Coadministration of the long-acting amylin analog cagrilintide plus the glucagon-like peptide-1 (GLP-1) agonist semaglutide, dubbed CagriSema, resulted in significantly greater weight loss, along with improved measures of glucose control, than either agent alone, in a small, short phase 2 trial of patients with type 2 diabetes. 

Juan P. Frias, MD, presented the findings here at the American Diabetes Association (ADA) 83rd Scientific Sessions, which were simultaneously published in The Lancet.

"Overall, in this phase 2 trial in people with type 2 diabetes, clinically relevant improvements in glycemic control — as assessed by A1c, [time in range], and other [continuous glucose monitoring (CGM)] measures — were observed with CagriSema, as well as weight loss of a magnitude not previously reported with pharmacotherapies in this population. CagriSema also had an acceptable safety profile," the researchers summarize.

"These data support further investigation of CagriSema in people with type 2 diabetes in longer and larger phase 3 studies," said Frias, from Velocity Clinical Research, Los Angeles, California.

In reply to audience questions, he said he was "pleasantly surprised" with the low gastrointestinal adverse events, which may have been related to the slower dosing titration. He also noted that patients in the study did not receive dietary counseling, unlike in the STEP-2 trial, where weight loss with semaglutide was greater than in this study.

Time in normal blood glucose range in the CagriSema group went from 40% at baseline to 89% at week 32, Chantal Mathieu, MD, PhD, reported during a follow-up presentation that focused on the trial's CGM findings.

"I was extremely happy that we were allowed to include CGM measurement because it does give you more information, especially in a short-term trial," said Mathieu, from the Katholieke Universiteit Leuven in Belgium. The CGM data were collected for 10 days preceding baseline and at weeks 20 and 32, she noted.

"At this point in time, it is difficult to make a final determination" about potential future clinical applications, session chair Elisabetta Patorno, MD, DrPH, from Harvard Medical School, Boston, Massachusetts, told Medscape Medical News. "This was a phase 2 randomized controlled trial, so more patients are needed," she noted.

"It's very interesting what was found with the use of CGM, which makes us think whether they should always be part of [trials] versus the more traditional A1c assessment," Patorno added.

'Synergistic Effect for Both Glycemic Control and Weight Loss'

"CagriSema is the next in a series of gut hormone analogs with the potential to herald a new era in treating obesity and preventing diabesity," the coexistence of type 2 diabetes and obesity, Caroline M. Apovian, MD, and Marie E. McDonnell, MD, both also from Harvard Medical School, write in an accompanying editorial in The Lancet.

Source: https://www.medscape.com/viewarticle/993665