Cagrilintide 5mg Perte de poids

Cagrilintide is a long-acting synthetic analog of human amylin, designed by Novo Nordisk to overcome the pharmacokinetic limitations of pramlintide (short half-life, multi-daily administration). The molecule is modified by acylation with a C18 fatty acid chain on the Lys22 residue, which maximizes serum albumin binding and extends plasma half-life to approximately 7 days in humans, compatible with weekly administration.

At the receptor level, Cagrilintide simultaneously activates the calcitonin receptor (CTR) and the amylin receptor complexes (AMY1, AMY2, AMY3) formed by association of CTR with receptor activity-modifying proteins (RAMPs). This signaling, distinct from that of GLP-1, produces an anorexigenic effect through complementary neuronal pathways: activation of catecholaminergic neurons in the solitary tract (NTS), modulation of satiety circuits in the hypothalamus, and GLP-1-independent slowing of gastric emptying.

In preclinical DIO (Diet-Induced Obesity) models, animals treated with Cagrilintide alone have shown a 11 to 13% weight reduction over 4 weeks, with preservation of lean mass. The most striking effect documented in the literature remains the synergy observed in co-administration with Semaglutide (CagriSema): full addition of anorexigenic effects, weight reduction exceeding 20% in clinical phase 2 at 32 weeks (Frias et al., Lancet 2023). This synergy has opened an entire field of exploration on amylin + GLP-1 combination that neither molecule alone can achieve.

Cagrilintide also modulates bone markers and calcium metabolism via the calcitonin pathway, which is the subject of parallel studies on bone mineral density and post-menopausal fractures. These avenues remain exploratory but broaden the research scope beyond pure energy metabolism.

Cagrilintide is a synthetic analogue of human amylin (hIAPP, Islet Amyloid Polypeptide, 37 aa, 3904 Da), a peptide hormone co-secreted with insulin by pancreatic β-cells whose sequence is closely conserved with calcitonin. Native human amylin shows amyloidogenic propensity (Aβ-like fibril formation in diabetic pancreatic islets) requiring stabilising modifications: cagrilintide incorporates (1) Pro25, Pro28, Pro29 substitutions (inherited from pramlintide) blocking β-sheet propensity and fibrillisation, (2) an Arg18 substitution improving solubility, and (3) a C20 diacid acylation (eicosanedioic acid) on Lys8 via γ-Glu/OEG linker, conferring reversible plasma albumin binding responsible for its exceptional half-life (~180 hours, compatible with weekly administration). Pharmacologically, cagrilintide activates hybrid receptors AMY1R, AMY2R, AMY3R (calcitonin-receptor + RAMP1/2/3 complexes), the amylin/CGRP receptor family, and more weakly the calcitonin receptor CTR. Signalling pathways include adenylate cyclase activation (cAMP), glucagon suppression, slowed gastric emptying, and central action on arcuate hypothalamic nucleus (POMC/CART neurons) for satiety.

The scientific database on Cagrilintide rapidly took shape between 2020 and 2024 around four reference trials published or presented at major congresses (ADA, EASD, ObesityWeek).

The pivotal phase 2 study by Lau et al., published in The Lancet in 2021 (DOI: 10.1016/S0140-6736(21)00845-X), evaluated Cagrilintide as monotherapy in 706 overweight or obese adults, randomized between placebo, liraglutide 3.0mg and Cagrilintide at escalating doses (0.3, 0.6, 1.2, 2.4, 4.5 mg weekly). At 26 weeks, weight reduction reached 10.8% in the Cagrilintide 4.5mg group, 8.0% at 2.4mg, versus 9.0% for liraglutide 3.0mg and 3.0% for placebo. The tolerance profile proved more favorable than that of liraglutide with fewer transient gastrointestinal effects.

The CagriSema combination study (Frias et al., Lancet 2023, DOI: 10.1016/S0140-6736(23)01163-7) evaluated 92 adults with type 2 diabetes, randomized between Semaglutide 2.4mg, Cagrilintide 2.4mg and the CagriSema 2.4mg/2.4mg combination. At 32 weeks, weight reduction reached 15.6% in the CagriSema group, versus 5.1% for Cagrilintide alone and 5.1% for Semaglutide alone. HbA1c dropped by 2.2% absolute in the combination group. This additive synergy was the trigger for the phase 3 REDEFINE program.

The REDEFINE program (phase 3, initiated late 2023) includes five active trials, including REDEFINE-1 (obesity without diabetes) and REDEFINE-2 (type 2 diabetes). Initial partial readouts presented at ADA 2024 confirm a weight reduction exceeding 20% at 68 weeks for CagriSema, a value unmatched to date in the incretin class outside Retatrutide. Complete results are expected for 2025-2026.

In preclinical research, work by Jensen et al. (Cell Reports Medicine 2022) on C57BL/6J mouse models subjected to a high-fat diet documented a 40% reduction in spontaneous caloric intake under Cagrilintide at 100 µg/kg weekly, with a 23% weight reduction over 8 weeks. c-Fos brain imaging confirmed preferential activation of the solitary tract nuclei and area postrema, corroborating the central amylin mechanism.

On the safety front, cumulative phase 2 and early phase 3 data indicate a gentler gastrointestinal profile than GLP-1 agonists, with no notable signal on cardiovascular, renal or hepatic parameters. The most frequent effects remain transient nausea (dose-dependent) and injection-site reactions. No measurable neoplasia has been reported in extension follow-up beyond 52 weeks.

Cagrilintide preclinical models focus on weight reduction and glycaemic control. In DIO (Diet-Induced Obesity) Sprague-Dawley rat model: SC administration 1-5 nmol/kg weekly over 4-8 weeks, dose-dependent weight loss 8-20% vs control, significant reduction in daily food intake (Lau et al., J Med Chem 2015 — reference paper for preclinical cagrilintide). In ZDF (Zucker Diabetic Fatty) rat model: improved fasting glycaemia, decreased rodent HbA1c, postprandial glucagon suppression. In non-human primate (cynomolgus) model: pharmacokinetics confirming extended ~7-day half-life, SC bioavailability > 80%. The cagrilintide + semaglutide combination (CagriSema co-formulation) produces documented additive effects on body weight and glycaemic profile in DIO rats and primates, justifying current clinical development at Novo Nordisk (REDEFINE and REIMAGINE trials). Additivity mechanisms involve convergence of GLP-1R (semaglutide) and AMY-R/CTR (cagrilintide) pathways on hypothalamic appetite regulation nuclei.