Cagrilintide vs Efpeglenatide
Comprehensive side-by-side comparison of mechanisms, dosing, side effects, and research
Also: AM833, NN9838
Cagrilintide (also called AM833) is a long-acting synthetic analog of amylin, the gut-brain satiety hormone co-secreted with insulin by pancreatic beta cells. It is an investigational once-weekly injectable being developed by Novo Nordisk for obesity, most prominently as the amylin half of CagriSema (cagrilintide plus semaglutide). It is not yet approved as a standalone drug, but it has cleared phase 2 trials and is in late-stage development.
Also: Eppe, HM11260C
Efpeglenatide is a long-acting, once-weekly GLP-1 agonist from Hanmi Pharmaceutical, made by linking an exendin-4 analog to an antibody fragment so it lasts days instead of hours. Sanofi licensed it for diabetes in 2015 and handed it back in 2020 despite a positive heart outcomes trial. Hanmi relaunched it for obesity, and on 7 October 2026 South Korea approved it as Eppe, the country's first homegrown GLP-1 obesity drug. It is not approved by the FDA or EMA.
Key Comparison Insights
- Both peptides belong to the Weight Loss category, suggesting similar primary applications.
Detailed Comparison
| Attribute | Cagrilintide | Efpeglenatide |
|---|---|---|
| Category | Weight Loss | Weight Loss |
| FDA Status | Not FDA Approved | Not FDA Approved |
| Clinical Status | Pre I II III IV FDA | Pre I II III IV FDA |
| Mechanism of Action | Cagrilintide is a non-selective agonist of the amylin and calcitonin receptor family. It activates amylin receptors (which are calcitonin receptors paired with RAMP accessory proteins) to signal satiety in the brain, slow gastric emptying, and blunt the post-meal glucagon rise. Mechanistic work in mice shows it reduces body weight mainly through amylin receptors AMY1R and AMY3R acting in the hindbrain, with the area postrema as a key entry point and downstream signaling through the nucleus of the solitary tract and parabrachial nucleus. Notably, weight loss in those studies persisted even after the acute appetite-suppressing effect faded, hinting at effects on energy balance beyond simple food-intake reduction. Chemically it is built on a pramlintide-like 37-amino-acid backbone with substitutions and a fatty-diacid chain attached to extend its half-life to roughly a week, enabling once-weekly dosing. | Efpeglenatide activates the GLP-1 receptor, which raises insulin release after meals, lowers glucagon, slows stomach emptying and reduces appetite. The active part is an exendin-4 analog (the same parent peptide as exenatide and lixisenatide) attached through a small linker to a human IgG4 Fc fragment, using Hanmi's LAPSCOVERY platform. The Fc piece makes the molecule big enough to dodge kidney clearance and lets it recycle in the body, which stretches its half-life to weekly dosing. Hanmi argues its lower brain penetration explains the milder GI profile; that is a company argument rather than an independently proven fact. |
| Common Dosing | 2.4 mg weekly Once weekly | 10 mg once weekly maintenance (Korean label) Once weekly |
| Administration | Subcutaneous injection once weekly | Subcutaneous auto-injector once weekly |
| Typical Duration | Long-term / chronic use expected | Long-term (chronic weight management); 40-64 weeks in the Korean phase 3 |
| Best Time to Take | Any consistent time weekly | Same day each week |
Possible Side Effects May vary by individual |
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| Research Summary | Cagrilintide has real human data, which sets it apart from most peptides in this category. In a 2021 Lancet phase 2 dose-finding trial (Lau et al.), once-weekly cagrilintide at 4.5 mg produced about 10.8% mean body weight loss over 26 weeks, beating both placebo (around 3%) and liraglutide 3.0 mg (around 9%), establishing that amylin agonism alone can drive clinically meaningful weight loss. Its bigger story is combination therapy: paired with semaglutide as CagriSema, it advanced into phase 3 REDEFINE trials for obesity and type 2 diabetes, with reported weight loss in the low 20% range, though final results came in somewhat below the most optimistic expectations. Side effects are dominated by the expected gastrointestinal effects (nausea, vomiting) common to gut-hormone drugs. As of 2026 cagrilintide is investigational and not FDA-approved on its own. The evidence is genuinely human and well-controlled here, which is rare, but it is still a drug under regulatory review rather than an approved therapy. | The strongest data come from Sanofi's AMPLITUDE-O trial (NEJM 2021), which enrolled people with type 2 diabetes and cardiovascular or kidney disease. Efpeglenatide 4 or 6 mg weekly cut major cardiovascular events by 27% versus placebo (7.0% vs 9.2%, hazard ratio 0.73) over a median of 1.8 years, and also reduced kidney outcomes. Sanofi still returned the rights in 2020 for business reasons. Hanmi then ran a Korean phase 3 obesity trial in 448 adults without diabetes (average BMI 32): at 40 weeks, weight loss was 9.02% versus 0.89% on placebo, and 75.1% lost at least 5%. That is less weight loss than semaglutide or tirzepatide in their pivotal trials, though trial designs differ, and GI side effects were somewhat lower (diarrhea 17.6%, nausea 16.6%, vomiting 11.6%). Korea's MFDS approved it for chronic weight management on 7 October 2026, with launch planned for late October. Bottom line: a solid, proven drug class member with real outcome data, but modest weight loss and no Western approval. |
Frequently Asked Questions: Cagrilintide vs Efpeglenatide
What is the difference between Cagrilintide and Efpeglenatide?
Cagrilintide is a weight loss peptide that cagrilintide (also called am833) is a long-acting synthetic analog of amylin, the gut-brain satiety hormone co-secreted with insulin by pancreatic beta cells. it is an investigational once-weekly injectable being developed by novo nordisk for obesity, most prominently as the amylin half of cagrisema (cagrilintide plus semaglutide). it is not yet approved as a standalone drug, but it has cleared phase 2 trials and is in late-stage development. Efpeglenatide is a weight loss peptide that efpeglenatide is a long-acting, once-weekly glp-1 agonist from hanmi pharmaceutical, made by linking an exendin-4 analog to an antibody fragment so it lasts days instead of hours. sanofi licensed it for diabetes in 2015 and handed it back in 2020 despite a positive heart outcomes trial. hanmi relaunched it for obesity, and on 7 october 2026 south korea approved it as eppe, the country's first homegrown glp-1 obesity drug. it is not approved by the fda or ema. The main differences lie in their mechanisms of action and clinical applications.
Which is better, Cagrilintide or Efpeglenatide?
Neither is universally "better" - the choice depends on your specific goals. Cagrilintide is typically used for weight loss purposes, while Efpeglenatide is used for weight loss. Always consult with a healthcare provider to determine which may be appropriate for your situation.
Can Cagrilintide and Efpeglenatide be used together?
Some peptide protocols combine multiple compounds for synergistic effects. However, using Cagrilintide and Efpeglenatide together should only be considered under medical supervision, as both compounds have their own side effect profiles and potential interactions. Research on their combined use may be limited.