BIOBRIEF
The 68 week Phase 3 Reimagine 4 head to head in Type 2 diabetes found CagriSema matched tirzepatide on weight loss in patients who stayed on the trial drug (15.2% vs 15.8%) but missed on HbA1c, a standard long term blood sugar measure (1.9 vs 2.
Novo Nordisk's next obesity-drug hopeful, CagriSema, tied Eli Lilly's tirzepatide on weight loss in a 68-week Phase 3 head-to-head in Type 2 diabetes but fell short on blood-sugar control, according to Reimagine-4 data presented at the American Diabetes Association's 2026 meeting.
In adherent patients, CagriSema cut body weight by an average 15.2% at 68 weeks versus 15.8% for tirzepatide, meeting non-inferiority on that primary endpoint. On the second primary endpoint, CagriSema reduced HbA1c (a standard measure of long-term blood-sugar control) by 1.9 percentage points against 2.2 percentage points for tirzepatide, missing the bar on blood sugar. The study was designed to show CagriSema was at least as good as tirzepatide on both measures. It was, on one of the two.
The readout landed the same week Novo disclosed a separate Phase 3 miss. Ziltivekimab, an anti-inflammatory antibody, failed to significantly reduce major adverse cardiovascular events in the ZEUS trial in patients with established cardiovascular disease, chronic kidney disease and systemic inflammation. Novo is now pinning the drug's hopes on heart-failure and post-heart-attack readouts expected next year.
On a press call, CEO Mike Doustdar called the pair "a couple of setbacks" and said Novo is on the hunt for bolt-on deals. CagriSema is already filed with the FDA; the company is targeting a 2027 launch.
The question Doustdar's framing leaves open: if CagriSema runs this close to tirzepatide on the only endpoint it won, what does it differentiate on at launch?