Bofanglutide vs semaglutide in Chinese T2D

On 30 June 2026 Ming Liu and colleagues published a Phase 2b randomized trial in Annals of Internal Medicine comparing bofanglutide, a long-acting GLP-1 receptor agonist developed by Gan and Lee Pharmaceuticals, against semaglutide 1 mg weekly in 272 adults with type 2 diabetes at 37 sites in China^[1]. The trial tested four bofanglutide dosing schedules and found that the 18 mg biweekly arm produced the largest reduction in glycated haemoglobin among all five groups.

What the trial set out to do

The study (ClinicalTrials.gov: NCT06256549) was a Phase 2b, open-label, active-controlled multicenter trial^[2]. Researchers enrolled adults with a mean baseline HbA1c of 8.35 percent and a mean age of 50.8 years. Participants were assigned in a 1:1:1:1:1 ratio to one of five arms: bofanglutide 12 mg biweekly, 18 mg biweekly, or 24 mg biweekly, bofanglutide 24 mg weekly, or semaglutide 1 mg weekly. The primary endpoint was change in HbA1c from baseline at week 24.

The choice of semaglutide 1 mg weekly as the comparator reflects its status as a widely used GLP-1 reference standard in clinical trials involving Chinese patients with type 2 diabetes. Including an active comparator rather than placebo allowed the trial to position bofanglutide relative to an established therapy.

The efficacy findings

At week 24 the HbA1c reductions across the bofanglutide arms ranged from -1.87 to -2.32 percentage points^[1]. The 18 mg biweekly arm produced the greatest change at -2.28 percentage points (95 percent CI: -2.54 to -2.03), compared with -1.60 percentage points (95 percent CI: -1.85 to -1.35) in the semaglutide 1 mg weekly group. The treatment difference for the 18 mg biweekly arm versus semaglutide was -0.68 percentage points, favouring bofanglutide.

The 24 mg weekly arm also exceeded semaglutide on the primary endpoint, though the full per-arm results for all four bofanglutide groups and their confidence intervals are detailed in the published paper. Across all five arms, no episodes of severe hypoglycaemia were reported, and rates of any hypoglycaemia ranged from 0 to 3.8 percent for bofanglutide versus 1.9 percent for semaglutide.

The safety picture

Gastrointestinal adverse events were more frequent in the bofanglutide arms than in the semaglutide comparator arm. The trial reported GI adverse event rates of 81.8 to 87.3 percent across the four bofanglutide groups, compared with 51.9 percent in the semaglutide 1 mg weekly group. The majority of these events were grade 1 or 2 in severity, meaning they were mild to moderate and did not require treatment discontinuation in most cases. The investigators described the GI profile as generally manageable.

The higher GI rate in the bofanglutide arms is notable. In the broader GLP-1 class the GI burden at initiation and during dose escalation is a known driver of early discontinuation. Whether the bofanglutide GI rates observed in this Phase 2b population would translate to clinically meaningful dropout differences in a longer Phase 3 trial is a question the current data cannot answer.

What this is not

This is a Phase 2b trial, not a Phase 3 efficacy or outcomes study. It was conducted exclusively in Chinese adults with type 2 diabetes at Chinese clinical sites, so the population, diet context, background medication use, and diabetes management practices may differ from populations in Western Europe, North America, or elsewhere. The 24-week duration captures glycaemic control but does not address longer-term outcomes such as cardiovascular events, kidney endpoints, or body-weight durability.

Bofanglutide is not approved by the FDA, the EMA, the MHRA, or any regulatory agency outside of its current development pathway. It is an investigational compound and there is no authorised product for patients to access at this time. The trial results are the output of a dose-ranging study designed to inform dose selection for future Phase 3 evaluation, not a basis for prescribing or sourcing a product.

The comparator was semaglutide 1 mg weekly, which is the subcutaneous GLP-1 dose used in type 2 diabetes management. It is not the 2.4 mg weekly obesity dose. Comparing bofanglutide efficacy with semaglutide 2.4 mg data from obesity trials would not be a valid reading of this study.

Why this trial adds to the incretin picture

The incretin class is increasingly competitive, with tirzepatide, retatrutide, and oral formulations of semaglutide all in late-stage development alongside the established subcutaneous agents. Bofanglutide is the first GLP-1 receptor agonist developed and trialled at scale by a Chinese pharmaceutical company to be published in a major Western clinical journal with a head-to-head design against semaglutide. That makes the trial significant for its context as much as its pharmacology.

From a science standpoint, a biweekly dosing interval that maintains or exceeds the glycaemic effect of a weekly competitor is a meaningful formulation objective. If Phase 3 data confirm the Phase 2b efficacy profile and show that the GI burden is manageable over a longer horizon, bofanglutide would represent an alternative dosing schedule within the semaglutide competitive space. For now, the Phase 2b result is a point of scientific interest and a signal for Phase 3 design, not a treatment option.

This article is for informational and educational purposes only. It is not medical advice. If you have type 2 diabetes or are considering any treatment, consult a qualified healthcare provider who can assess your individual situation.