Eloralintide vs cagrilintide

Lilly's amylin drug against Novo's — which has the stronger case so far?

No head-to-head trial — cross-trial comparison
In one paragraphCagrilintide is further along: two published phase 3 trials in combination with semaglutide (CagriSema), and an 11.8% monotherapy arm at 68 weeks inside the larger of them. Eloralintide has one published phase 2 — 263 people, 48 weeks — with up to 20% weight loss alone and a fatigue signal no other drug in the class shows. Neither is approved, no trial compares them, and both companies plan to pair their amylin drug with an incretin.

Side by side

C EloralintideB Cagrilintide
LYO gradeCB
DeveloperEli LillyNovo Nordisk
Best published trialPhase 2, n=263, 48 wk (Lancet 2025)Phase 3 REDEFINE 1, n=3,417, 68 wk (NEJM 2025; with semaglutide)
Weight loss aloneUp to −20% (9 mg, 48 wk, efficacy estimand)−11.8% (68 wk, REDEFINE 1 arm, on-treatment)
Weight loss with an incretinNot yet published (tirzepatide combination in trials)−20.4% ITT / −22.7% on treatment with semaglutide (CagriSema)
Signature side effectFatigue in up to 46%; nausea dose-dependent (up to 64% at fixed 6 mg)Nausea and vomiting, GLP-1-like; GI events ~80% with semaglutide
Half-lifeWeekly; figure not in the abstractAbout 7–8 days
Approval statusInvestigational, phase 3 runningInvestigational; CagriSema filing planned
Sport (WADA)Prohibited (S0)Prohibited (S0)
Verdict

Cagrilintide on evidence — phase 3, published, in 4,600 people across two trials. Eloralintide on the single number — 20% alone at 48 weeks against cagrilintide's 11.8% alone at 68 — from a trial a tenth the size. Wait for eloralintide's phase 3 before believing the gap.

Same receptor, different bets

Both are long-acting analogues of amylin, the satiety hormone released with insulin. Novo's bet was the combination: cagrilintide was designed to be co-injected with semaglutide, and its phase 3 programme tested the pair. Lilly's bet is selectivity: eloralintide was built to hit the amylin receptor and not the calcitonin receptor, and its published trial is monotherapy. Petrelintide, the third entrant, sits between them.

Why the numbers are not comparable

Eloralintide's 20% is an efficacy estimand — participants who stopped are not fully counted — over 48 weeks in 263 people. Cagrilintide's 11.8% is an on-treatment figure over 68 weeks from a 302-person arm inside a 3,417-person trial. Different durations, estimands and populations; the only conclusion is that both do something substantial on their own. The fatigue signal is the one qualitative difference worth watching.

What would settle it

Eloralintide's phase 3 readouts, alone and with tirzepatide, and CagriSema's head-to-head against tirzepatide (REDEFINE 4). Until then this page compares a phase 2 with a phase 3, which is not a fair fight and says so.

Questions people actually ask

Which is better, eloralintide or cagrilintide?
Unknown. Cagrilintide has phase 3 evidence; eloralintide has a bigger single number from a smaller trial. No direct comparison exists.
Can you buy either?
No. Both are investigational; anything sold under either name is unlicensed and not the trial product.
Why does eloralintide cause fatigue?
Not established. It appeared in up to 46% of participants at the higher doses in phase 2 and is not a known effect of cagrilintide or the GLP-1 drugs.

References

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