{"id":"ecnoglutide","name":"Ecnoglutide","aliases":["XW003","cAMP-biased GLP-1 agonist"],"url":"https://lyoresearch.com/compounds/ecnoglutide","class":{"id":"glp-1-agonists","name":"GLP-1 and incretin agonists","url":"https://lyoresearch.com/classes/glp-1-agonists"},"summary":"Ecnoglutide is a once-weekly GLP-1 receptor agonist developed by Sciwind Biosciences in China, engineered to favour the cAMP signalling pathway. In a 664-person phase 3 trial published in 2025, Chinese adults with overweight or obesity lost 13.2% at 40 weeks on the top dose against 0.1% on placebo. Two phase 3 diabetes trials are also published. It is not approved in any region this site covers.","overall_grade":"B","overall_grade_meaning":"probable, not settled","human_trials":"3 phase 3 RCTs published (obesity n=664; two in diabetes)","regulatory_status":"Investigational (phase 3 published)","molecule":{"formula":"C194H304N48O61","molecular_weight":"4285","cas":"2459531-73-6","pubchem_cid":162625103,"note":null},"pharmacokinetics":{"basis":"human","route":"Subcutaneous, once weekly","half_life":"About 5–6 days at steady state (124–138 hours)","licensed_regimen":null,"product":null,"source":{"title":"Pan H, et al. Discovery of ecnoglutide — a novel, long-acting, cAMP-biased GLP-1 analog. Mol Metab 2023;75:101762","url":"https://www.sciencedirect.com/science/article/pii/S2212877823000960"}},"outcomes":[{"outcome":"Body weight","grade":"B","grade_meaning":"probable, not settled","effect_size":"large","adverse":false,"human_studies":"1 phase 3 RCT (n=664, 40 wk)","evidence":"Three doses against placebo across 36 Chinese centres. Loss of 9.1%, 10.9% and 13.2% at 1.2, 1.8 and 2.4 mg against 0.1% on placebo. Shorter than the 68–72-week Western trials, so not directly comparable.","references":[{"citation":"Ji L, et al. Efficacy and safety of a biased GLP-1 receptor agonist ecnoglutide in adults with overweight or obesity: a multicentre, randomised, double-blind, placebo-controlled, phase 3 trial.","where":"Lancet Diabetes Endocrinol, 2025","url":"https://pubmed.ncbi.nlm.nih.gov/40555243/"}],"verbatim":{"text":"At week 40, the least-squares mean percentage change in bodyweight was -9·1% (SE 0·8) in the ecnoglutide 1·2 mg group, -10·9% (0·9) in the ecnoglutide 1·8 mg group, and -13·2% (0·8) in the ecnoglutide 2·4 mg group versus 0·1% (0·8) in the placebo group, and the respective estimated treatment differences compared with placebo were -9·2% (97% CI -11·0 to -7·5), -11·1% (-13·1 to -9·1), and -13·3% (-15·3 to -11·3), respectively (all p<0·0001).","citation":"Ji L, et al. Efficacy and safety of a biased GLP-1 receptor agonist ecnoglutide in adults with overweight or obesity: a multicentre, randomised, double-blind, placebo-controlled, phase 3 trial.","url":"https://pubmed.ncbi.nlm.nih.gov/40555243/"}},{"outcome":"Blood glucose (HbA1c) in type 2 diabetes","grade":"B","grade_meaning":"probable, not settled","effect_size":"large","adverse":false,"human_studies":"2 phase 3 RCTs (EECOH-1, EECOH-2)","evidence":"A placebo-controlled monotherapy trial and a 52-week non-inferiority trial against dulaglutide, both published in 2025.","references":[{"citation":"Efficacy and safety of cAMP signalling-biased GLP-1 analogue ecnoglutide monotherapy versus placebo in patients with type 2 diabetes (EECOH-1): a phase 3 trial.","where":"Nat Commun, 2025","url":"https://pubmed.ncbi.nlm.nih.gov/?term=ecnoglutide+EECOH-1+phase+3"},{"citation":"Efficacy and safety of cAMP-biased GLP-1 receptor agonist ecnoglutide versus dulaglutide in patients with type 2 diabetes (EECOH-2): a 52-week non-inferiority phase 3 trial.","where":"Lancet Diabetes Endocrinol, 2025","url":"https://pubmed.ncbi.nlm.nih.gov/?term=ecnoglutide+EECOH-2+dulaglutide"}]},{"outcome":"GI side effects","grade":"B","grade_meaning":"probable, not settled","effect_size":"moderate","adverse":true,"human_studies":"Same RCTs","evidence":"The class profile. Ten of 499 people on ecnoglutide stopped for adverse events in the obesity trial.","references":[{"citation":"Ji L, et al. Efficacy and safety of a biased GLP-1 receptor agonist ecnoglutide in adults with overweight or obesity: a multicentre, randomised, double-blind, placebo-controlled, phase 3 trial.","where":"Lancet Diabetes Endocrinol, 2025","url":"https://pubmed.ncbi.nlm.nih.gov/40555243/"}],"verbatim":{"text":"The most common adverse events were mild-to-moderate gastrointestinal related events.","citation":"Ji L, et al. Efficacy and safety of a biased GLP-1 receptor agonist ecnoglutide in adults with overweight or obesity: a multicentre, randomised, double-blind, placebo-controlled, phase 3 trial.","url":"https://pubmed.ncbi.nlm.nih.gov/40555243/"}}],"regions":[{"region":"European Union","status":"Not authorised","note":"No EMA application known at review."},{"region":"United States","status":"Not approved","note":"Not FDA-approved. Products sold under the name are unlicensed."},{"region":"United Kingdom","status":"Not licensed","note":"No MHRA licence."},{"region":"Australia","status":"Not on the ARTG","note":"Not registered."},{"region":"Canada","status":"Not authorised","note":"No Drug Identification Number."},{"region":"Sport (WADA)","status":"Prohibited at all times","note":"Not approved by any of the regulators WADA recognises, so S0 (non-approved substances)."}],"faq":[{"q":"What does 'biased' GLP-1 agonist mean?","a":"The molecule is designed to trigger one of the receptor's two signalling pathways (cAMP) more than the other (β-arrestin). The hope is more effect and less receptor fatigue; the trials so far do not test that claim against an unbiased drug."},{"q":"How does ecnoglutide compare with semaglutide?","a":"13.2% at 40 weeks against semaglutide's 14.9% at 68 weeks — different durations, different populations, no direct trial."},{"q":"Is ecnoglutide approved?","a":"Not in the EU, US, UK, Australia or Canada. Its development and regulatory review are in China."}],"references":[{"cite":"Ji L, et al. Efficacy and safety of a biased GLP-1 receptor agonist ecnoglutide in adults with overweight or obesity: a multicentre, randomised, double-blind, placebo-controlled, phase 3 trial.","where":"Lancet Diabetes Endocrinol, 2025","url":"https://pubmed.ncbi.nlm.nih.gov/40555243/","note":"664 randomised, 36 Chinese centres, 40 weeks. NCT05813795."},{"cite":"Efficacy and safety of cAMP signalling-biased GLP-1 analogue ecnoglutide monotherapy versus placebo in patients with type 2 diabetes (EECOH-1): a phase 3 trial.","where":"Nat Commun, 2025","url":"https://pubmed.ncbi.nlm.nih.gov/?term=ecnoglutide+EECOH-1+phase+3"},{"cite":"Efficacy and safety of cAMP-biased GLP-1 receptor agonist ecnoglutide versus dulaglutide in patients with type 2 diabetes (EECOH-2): a 52-week non-inferiority phase 3 trial.","where":"Lancet Diabetes Endocrinol, 2025","url":"https://pubmed.ncbi.nlm.nih.gov/?term=ecnoglutide+EECOH-2+dulaglutide"}],"last_reviewed":"2026-09-23","literature_searched_to":"2026-09-23","changelog":[{"date":"2026-09-23","note":"Initial publication from the Lancet Diabetes & Endocrinology phase 3. Grade B: published phase 3, unapproved, single-country."}],"license":"CC BY 4.0 — cite as “LYO Research” with a link.","methodology":"https://lyoresearch.com/methodology"}