Video transcript
If we look at the results of this class, we can see really impressive improvements and reductions in weight. That is going to be really important for these treatments moving forward because we’re looking for more choice for patients. We’re looking for highly efficacious weight loss therapies which we can use in the clinic. Hello, I’m Melanie Davies and I’m a professor of diabetes medicine at the University of Leicester in the United Kingdom. So I’m an investigator, but also the principal investigator for REDEFINE 2, which was a trial investigating CagriSema in people with overweight and obesity and type 2 diabetes. So, the rationale for combining a GLP-1 such as semaglutide with an amylin analogue such as cagrilintide is that we want to get the benefit of a dual formulation. So, we know that GLP-1 reduces appetite, reduces weight. It’s been shown in large outcome studies to also offer organ protection. But if we want to enhance the weight loss, we can add different targets, and in this case it’s amylin. We know that amylin has a role in weight loss. Also, in animals it’s been shown to increase energy expenditure, which may help to mitigate the effects of metabolic adaptation. And we also know it may play a role in bone health. So, combining these two agents together may potentiate the weight loss that we see with semaglutide alone. The reason that we’re looking at the combination of cagrilintide and semaglutide together is that we also know that amylin has an excellent effect on glucose levels, on glycaemic control. We’ve seen the use of short-acting amylin analogues such as pramilintide have a role in terms of reducing glucose. So, we would expect to see, along with really good weight loss, we would expect to see an advantage in terms of glucose-lowering of combining semaglutide with cagrilintide. We already have GLP-1/GIP co-agonists which have been, such as tirzepatide, which have been shown in programmes such as the SURPASS programme and the SURMOUNT programme to be very effective both in glucose lowering but also weight loss in people with and without type 2 diabetes. So, for the combination of CagriSema this has been tested in a phase 2 programme which showed really good results in terms of weight loss, but also on glycaemic control. And the REDEFINE trials, REDEFINE 1 and REDEFINE 2, have examined the combination of CagriSema in people with and without type 2 diabetes, the main outcome being weight loss, but also looking at secondary endpoints including in the patients with diabetes, impact on HbA1c, but also broadly impacts on cardiometabolic risk factors, and also on physical function. The results of the phase 3 programme with CagriSema, REDEFINE 1 and REDEFINE 2, were presented at the ADA in 2025 and also published in the New England Journal of Medicine in 2025. REDEFINE 1 was the larger trial in people without type 2 diabetes, around 3,400 patients, in which CagriSema was compared to either both of the mono-components as well as placebo. REDEFINE 2 was in around 1,200 patients with type 2 diabetes comparing CagriSema to placebo. Both studies met their primary endpoint. So, for example, in REDEFINE 2, in the what we call the trial-product estimand, which is almost the per-protocol result, there was a 15.7 % mean weight loss in people with type 2 diabetes. In people without diabetes that was over 22 % mean weight loss. We also saw significant improvements in glycaemic control. So, for example, in REDEFINE 2, there was a 2.1 % reduction in HbA1c from a baseline of 8 %. We saw improvements in physical function and we also saw important improvements in cardiometabolic risk factors, including significant reductions in waist circumference, significant reductions in high-sensitivity CRP, as well as blood pressure and lipid profiles. If we look at the results of this class, we can see really impressive improvements and reductions in weight. So, for example, in the type 2 patients, more than 90 % of patients were able to achieve weight loss of at least 5 %. And we could also see that around a third of patients were able to achieve 20 % weight loss. So, that is going to be really important for these treatments moving forward because we’re looking for more choice for patients. We’re looking for highly efficacious weight loss therapies which we can use in the clinic. Also, I think, the mechanism of action, particularly with the amylin, is of interest, for example, at looking at body composition and bone health in the future. So, we need to see data with amylin in that regard. There’s a whole raft of molecules coming through that also target glucagon and even triple agonists. So, it would be interesting to see how the field develops over the next couple of years, where we’re going to have a real wealth of potential tools for us to use in the clinic. It’s interesting what the role of bariatric surgery will be in the future. We still know that that’s the most powerful intervention that we have for weight loss, but we can see some of these molecules coming through really are starting to match the performance of bariatric surgery. In the past, we’ve had surgical procedures which have been very common in our practise. If we look back decades ago, we used to use surgical procedures, for example, for gastric ulcers. Now that has completely disappeared and medicines now manage that. So, in the future we may get to a place where we can manage this through lifestyle interventions, combined with these really efficacious medications, which also, because they target different hormones, may allow us to use a more personalised approach. But at the moment, there’s still a massive gap between the clinical need and what’s available. And so, there’s still quite a role for bariatric surgery at the current time.