Eloralintide vs Cagrilintide: Two Long-Acting Amylin Analogues

Eloralintide and cagrilintide are both long-acting amylin analogues given once a week, and the main pharmacological difference between them is receptor selectivity. Eloralintide, from Eli Lilly, preferentially activates the amylin 1 receptor. Cagrilintide, from Novo Nordisk, is a non-selective agonist that also activates the calcitonin receptor. Neither is approved, and no trial has compared them.

They have also taken different routes through development. Cagrilintide has mostly been studied in a fixed combination with semaglutide, called CagriSema. Eloralintide has mostly been studied on its own, and is now also being tested with tirzepatide.

What amylin analogues do

Amylin is a hormone released by the pancreas together with insulin. Reviews of the class describe it as slowing gastric emptying, suppressing glucagon secretion and promoting satiation through actions in the brain (Fischer 2026). Pramlintide, the first approved amylin analogue, found limited use as an add-on to insulin therapy (Bailey 2026). Eloralintide and cagrilintide belong to a newer group engineered to last long enough for weekly injection.

Amylin receptors are complexes built on the calcitonin receptor (Bailey 2026), which is why selectivity between amylin receptors and the calcitonin receptor itself is the axis these drugs are compared on.

What each one is

• Eloralintide (LY3841136). In cell assays it activated the human amylin 1 receptor about 12-fold more potently than the calcitonin receptor and 11-fold more than the amylin 3 receptor (Briere 2025). Peptide Library has no profile for it yet; this article cites its trials directly.

• Cagrilintide. A long-acting amylin analogue (Lau 2021), described in reviews as a dual amylin and calcitonin receptor agonist (Bailey 2026). See the cagrilintide profile and the cagrilintide guide.

Why selectivity is the question

The argument for a selective agonist comes from animal work. In lean rats, eloralintide caused significantly less conditioned taste avoidance, a measure of aversion, than cagrilintide (Briere 2025). That study was run by eloralintide's developer, in rats, and does not show how either drug feels to people. A 2026 review frames the open question the same way: calcitonin receptor engagement, exposure and the brain circuits recruited may influence whether reduced food intake reflects ordinary satiation or aversive signalling, and so how much nausea and malaise these drugs cause (Fischer 2026).

What the published trials measured

The two programmes have studied different populations with different designs, so each is described on its own. We have not copied weight-loss percentages from them side by side, because across separate trials those numbers invite a ranking the evidence cannot support.

Eloralintide

• Phase 1, single doses. 48 healthy participants received single doses from 0.04 to 12 mg or placebo (Briere 2025).

• Phase 1, 12 weeks. 100 participants with obesity or overweight received once-weekly doses in five ascending cohorts without dose escalation. The most common adverse events were decreased appetite (19%), headache (12%) and fatigue (11%); diarrhoea (10%), nausea (8%) and vomiting (4%) were infrequent (Bhattachar 2026).

• Phase 2, 48 weeks. 263 adults without type 2 diabetes were randomised to placebo, 1, 3, 6 or 9 mg once weekly, or one of two escalation schemes ending at 9 mg. Weight fell in a dose-dependent way compared with placebo; nausea and fatigue were the most common adverse events (Billings 2025).

• Phase 3. Lilly has registered several trials, including one comparing EloraTZP with tirzepatide alone, eloralintide alone and placebo over 100 weeks (NCT07881432). None has reported.

Cagrilintide

• Phase 2, 26 weeks. 706 adults without diabetes were randomised to cagrilintide 0.3, 0.6, 1.2, 2.4 or 4.5 mg once weekly, with liraglutide 3.0 mg and placebo as comparators, after up to 6 weeks of dose escalation. All doses reduced weight more than placebo. The most frequent adverse events were gastrointestinal (41–63% of participants on cagrilintide against 32% on placebo) and injection-site reactions (Lau 2021).

• REDEFINE 1, phase 3, 68 weeks. 3,417 adults with overweight or obesity were randomised to cagrilintide 2.4 mg plus semaglutide 2.4 mg, either drug alone, or placebo. The trial's primary comparison was the combination against placebo (Garvey 2025). See CagriSema and the CagriSema guide.

• REIMAGINE 2, phase 3, 68 weeks. 2,713 people with type 2 diabetes received CagriSema at two strengths, semaglutide alone, cagrilintide 2.4 mg alone or placebo. It is one of the few designs that reports cagrilintide on its own; adverse events were reported in 82.2% of the cagrilintide-alone group and 70.5% of the placebo group, mostly gastrointestinal (Buse 2026).

Indirect comparisons

A 2026 network meta-analysis pooled six trials of newer amylin-based therapies, including eloralintide and CagriSema, and ranked them. Its authors describe the data as sparse and low-certainty and the findings as preliminary (Kamrul-Hasan 2026). A ranking built from separate trials is a hypothesis, not a head-to-head result.

What the evidence does not show

• Which one causes more weight loss. No trial has randomised people to eloralintide versus cagrilintide.

• Whether selectivity improves tolerability in people. The taste-avoidance finding is from rats. No human study has compared the two drugs' side effects.

• What cagrilintide does alone at scale. Most of its phase 3 data are for the combination with semaglutide; weight change on CagriSema cannot be attributed to cagrilintide alone.

• Long-term outcomes. Neither drug has reported a cardiovascular outcomes trial.

The vial math

For research arithmetic, concentration depends only on vial mass and water volume, not on which amylin analogue is in the vial. The cagrilintide calculator works through common cagrilintide vials, and the general peptide calculator handles any other.

Frequently asked questions

Are eloralintide and cagrilintide the same kind of drug?

Yes, both are long-acting amylin analogues. They differ in receptor selectivity: eloralintide prefers the amylin 1 receptor, while cagrilintide also activates the calcitonin receptor.

Which is better, eloralintide or cagrilintide?

The evidence cannot say. No trial has compared them directly, and their trials differ in population, length and combination partner.

Is cagrilintide the same as CagriSema?

No. CagriSema is cagrilintide combined with semaglutide. Cagrilintide is one of its two components.

How does eloralintide compare with retatrutide?

They work on different hormone systems. The eloralintide vs retatrutide comparison covers that pair.