New amylin agonists for obesity and T2D

Amylin-based medicines are becoming a second thread in the obesity and type 2 diabetes drug pipeline. A 2026 narrative review identifies three frontrunners: zenagamtide, eloralintide, and cagrilintide plus semaglutide, known as CagriSema. The early results are large enough to attract attention, but the agents are not at the same stage of evidence^[1].

The review is a map of a fast-moving field, not a head-to-head trial. Its figures come from different populations, study lengths, formulations and estimands. They describe trial results reported for particular products rather than a promise of comparable results in ordinary care. The evidence is early. A reader comparing the reported percentages should first ask which product was studied, whether participants had obesity or type 2 diabetes, how long follow-up lasted, and whether the result came from a phase 1, phase 2 or phase 3a programme.

What makes an amylin-based agonist different

Amylin is a hormone involved in appetite and metabolic signalling. The review groups agents by how they target amylin pathways. Zenagamtide, formerly amycretin, is a single molecule designed to act at both amylin and GLP-1 receptors. Eloralintide is described as a long-acting, mostly AMY1 receptor agonist. CagriSema combines cagrilintide with semaglutide^[1].

That last distinction matters. CagriSema includes the same GLP-1 medicine discussed in our semaglutide guide, while the other two candidates use different designs. A category label does not make their efficacy or adverse-event profiles interchangeable.

Zenagamtide has early efficacy data

The review reports weight loss up to 13.1% after 85 days for oral zenagamtide in a phase 1 obesity study. In a subcutaneous phase 1b/2a study lasting 36 weeks, reported weight loss reached up to 24.3%^[1]. Those are early-stage findings, so they should be read as signals from selected trial participants rather than established long-term effectiveness.

The short duration and early phase of the oral study are especially relevant. A large percentage result over 85 days cannot answer whether weight loss persists, how tolerability develops over longer treatment, or how the candidate compares directly with other obesity medicines.

Eloralintide and CagriSema have later-stage evidence

For eloralintide, the review cites weight loss up to 20.1% in a 48-week phase 2 study. It describes a distinct adverse-event profile that included fatigue, headache and appetite loss. The evidence remains preliminary, and the review calls for further trials before validation in clinical practice^[1].

CagriSema has the broadest type 2 diabetes evidence of the three in this review. In obesity, it produced weight loss up to 22.7% in a phase 3a study over 68 weeks. For type 2 diabetes, the review reports HbA1c reduction up to 2.0% using a trial-product estimand at 68 weeks^[1].

The authors also describe findings in treatment-naive type 2 diabetes and in people using basal insulin. In the latter setting, CagriSema reduced insulin dose by 20 units compared with the control arm in a 40-week phase 3a study^[1]. This is a reported trial outcome, not a dosing plan or a reason to alter insulin without clinician guidance.

Safety and comparison limits

The review says the safety profile of zenagamtide and CagriSema was broadly consistent with GLP-1 receptor agonists. That broad phrasing does not mean every adverse event is identical or that rare harms have been ruled out. Study duration, trial eligibility and how each study records adverse events all shape what a safety result can show^[1].

The numerical results also should not be used as a league table. A 36-week phase 1b/2a zenagamtide study, a 48-week phase 2 eloralintide study, and a 68-week phase 3a CagriSema study do not answer the same question. Direct comparisons would be needed to establish relative efficacy and tolerability. The review itself was narrative and searched PubMed/MEDLINE, Scopus and Google Scholar through June 2026. It brings together reported outcomes, but it does not turn separate trials into one shared study population. The candidates also differ in formulation: zenagamtide had oral and subcutaneous findings, while CagriSema is a co-administered combination. Those distinctions limit any numerical comparison across headlines^[1].

Where this leaves readers

The evidence suggests that amylin-based agonists may expand the options being studied for obesity and type 2 diabetes. CagriSema is the most developed of the three in type 2 diabetes within this review, while zenagamtide and eloralintide remain supported by earlier evidence. Our tirzepatide overview covers a separate incretin medicine often mentioned in the same wider discussion.

What we do not yet know

This narrative review cannot establish which amylin-based approach is best for an individual person, whether early weight-loss results persist, or how the candidates compare directly with established treatments. Further trials are needed, particularly trials that test long-term outcomes and make direct comparisons across relevant options^[1].

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