Two phase 3 trials of cagrilintide-semaglutide (CagriSema) in type 2 diabetes published together in The Lancet Diabetes & Endocrinology: REIMAGINE 1 in adults inadequately controlled on diet and exercise, and REIMAGINE 2 against semaglutide or cagrilintide alone in adults on metformin with or without an SGLT2 inhibitor.
The design of REIMAGINE 2 is the part worth noting now. It compares the fixed-dose combination against each of its components at matched dose, over 68 weeks, in 30 countries, with a continuous glucose monitoring subgroup built into the randomisation strata. A combination tested against its own components at the same doses is the design that can actually establish whether the pairing adds anything, as opposed to a combination tested against placebo, which cannot.
What this signals is a shift in where amylin agonism is being developed. Cagrilintide's visible programme has been weight-centred; two simultaneous phase 3 readouts in type 2 diabetes place it as a glycaemic proposition too. Effect sizes are not summarised here because they are not in the indexed abstract, and this edition does not report numbers it has not seen. Worth reading the papers directly before changing anything.
- REIMAGINE 1 and 2 published simultaneously in Lancet Diabetes & Endocrinology
- REIMAGINE 2 compares CagriSema against both components at matched dose, 68 weeks
- CGM subgroup built into the randomisation stratification
- Signals amylin agonism moving from a weight programme to a glycaemic one
- Effect sizes deliberately not quoted; the indexed abstract truncates before results
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