Which is better, semaglutide or cagrilintide?
Semaglutide wins on everything a patient can act on today: it is FDA approved for weight management and cardiovascular risk reduction, backed by STEP 1 and SELECT, and available by prescription. Cagrilintide has human_rct data but no approval, no lawful compounding pathway, and no long term safety or outcomes data; its main role is as an add-on to semaglutide, where REDEFINE 5 showed the combination beat semaglutide alone by 6.5 percentage points. [1] [2] [3] [4] [5] [6] [8]
How do semaglutide and cagrilintide compare?
| Dimension | SemaglutideFavored | Cagrilintide |
|---|---|---|
| Mechanism [3] [6] | GLP-1 receptor agonist: glucose dependent insulin release, glucagon suppression, slower gastric emptying, reduced appetite. | Long acting amylin analog acting on amylin and calcitonin receptors in the area postrema and hypothalamus to increase satiety and slow gastric emptying. |
| Note: Because the pathways are separate, the combination produces additive weight loss. | ||
| Weight loss alone [1] [3] [4] | STEP 1 (1,961 adults, 68 weeks): 14.9% with semaglutide 2.4 mg versus 2.4% on placebo. | Phase 2 (706 adults, 26 weeks): 6.0% to 10.8% across 0.3 to 4.5 mg versus 3.0% on placebo; 4.5 mg beat liraglutide 3.0 mg (10.8% versus 9.0%). |
| Note: Different durations and populations; REDEFINE 1 included semaglutide only and cagrilintide only arms (302 people each) as secondary comparators. | ||
| Combination evidence [4] [5] | Semaglutide 2.4 mg alone lost 11.9% in REDEFINE 5 (331 adults in Japan and Taiwan, 68 weeks). | Adding cagrilintide 2.4 mg raised loss to 18.4% in REDEFINE 5, and to 20.4% versus 3.0% placebo in REDEFINE 1 (3,417 adults). |
| Cardiovascular outcomes [2] [3] | SELECT (17,604 adults): hazard ratio 0.80 for major adverse cardiovascular events in obesity with cardiovascular disease. | No cardiovascular outcomes data reported. |
| Regulatory status [6] [7] [8] | FDA approved (Ozempic, Rybelsus, Wegovy). Compounding allowance ended after the shortage resolved in February 2025. | Not FDA approved alone or in combination. Not a component of an approved drug and not on the 503A bulks list, so it cannot lawfully be compounded. |
| WADA status [9] | Not on the WADA Prohibited List. | Prohibited at all times under section S0 (non-approved substances). |
| Side effects [1] [3] [4] | Nausea 44%, diarrhea 32%, vomiting 24%, constipation 24% in STEP 1; thyroid C-cell boxed warning. | Nausea 20% to 47% across doses versus 18% placebo in phase 2; with semaglutide, gastrointestinal events in 79.6% versus 39.9% on placebo in REDEFINE 1. |
| Access and cost [8] [10] | Prescription at a retail pharmacy; Wegovy list about 1,349 USD per month, manufacturer cash pricing roughly 349 to 499 USD. | No lawful US access outside a registered clinical trial; products sold online as research chemicals are not lawful for human use. |
Evidence grade and regulatory status
Pulled from each peptide’s own record, so it stays in step with the peptide pages.
| Attribute | Semaglutide | Cagrilintide |
|---|---|---|
| Class | GLP-1 receptor agonist (31 amino acid analog of human GLP-1, acylated for once weekly dosing) | Investigational long acting amylin analog (acylated, once weekly), developed alone and in fixed combination with semaglutide 2.4 mg |
| What it is | FDA approved GLP-1 agonist with about 15% average weight loss in a 68 week RCT and proven cardiovascular benefit. | Experimental weekly copy of the appetite hormone amylin: 10.8% weight loss alone at 26 weeks and 20.4% with semaglutide at 68 weeks; not FDA approved. |
| Evidence | Evidence: Human RCT evidence | Evidence: Human RCT evidence |
| FDA status | Regulatory: FDA approved | Regulatory: Not eligible for compounding |
| Compounding | FDA approved products (Ozempic 2017, Rybelsus 2019, Wegovy 2021). FDA removed semaglutide from the drug shortage list on February 21, 2025; compounding by 503A pharmacies had to stop by April 22, 2025 and by 503B outsourcing facilities by May 22, 2025, except for a documented patient specific clinical need. FDA has warned about unapproved compounded and counterfeit GLP-1 products and salt forms (semaglutide sodium, semaglutide acetate) that are not the approved active ingredient. On April 30, 2026 FDA proposed not to include semaglutide on the 503B bulks list; that proposal was not final as of September 2026. Adding a vitamin such as B12 or niacinamide does not by itself make a compounded GLP-1 different from the approved drug. Under FDA's April 1, 2026 policy update, such a combination may be treated as essentially a copy when the strengths are within 10% of approved products and the route is the same, unless a prescriber documents a real difference for the individual patient. A September 2026 FDA warning letter applied this to semaglutide and tirzepatide vitamin combinations, said high production volume suggested the claimed differences were a pretext, and questioned significant-difference statements picked from preset menus on prescribing platforms. | Not FDA approved as of the last verification date, either alone or in the fixed combination with semaglutide. Because cagrilintide is not a component of an approved drug, has no USP monograph, and is not on the 503A bulks list, it cannot lawfully be compounded. Any product sold as cagrilintide or CagriSema outside a clinical trial is an unapproved drug. Check FDA for the status of any marketing application before relying on this record. |
| WADA | WADA: Not WADA prohibited | WADA: WADA prohibited |
| Routes | Subcutaneous injection once weekly (Ozempic, Wegovy), Oral tablet once daily (Wegovy tablets, Ozempic tablets, Rybelsus) | Subcutaneous injection once weekly (clinical trials only) |
| Typical cost | Manufacturer list price is 1,349.02 USD per month for Wegovy and 1,027.51 USD for Ozempic (checked 2026-09-22), falling to 675 USD for both on January 1, 2027. Manufacturer self-pay prices run 149 to 499 USD per month by product and dose, with the Wegovy pen at 349 USD. With commercial insurance the manufacturer savings offer can bring a covered prescription to 25 USD per month, and eligible Medicare Part D enrollees pay 50 USD per month for Wegovy under the Medicare GLP-1 Bridge (July 2026 to December 2027). A 2024 study found compounded semaglutide at a median 231 USD for the first month during the shortage; compounding is now limited to patient specific needs. | Not available through licensed channels. Products sold as research chemicals are not lawful for human use and are not verified for identity or purity. |
| Last verified |
Has semaglutide been tested directly against cagrilintide?
| Study | Design and population | Outcome | Grade |
|---|---|---|---|
| Co-administered cagrilintide and semaglutide versus semaglutide alone in adults with overweight or obesity in Japan and Taiwan (REDEFINE 5)2026 PMID 42009015 | Randomized, double blind, active controlled phase 3a trial, 68 weeksn = 331 Adults with overweight or obesity in Japan and Taiwan | Weight change minus 18.4% with cagrilintide plus semaglutide versus minus 11.9% with semaglutide alone (difference minus 6.5 percentage points) | Evidence: Human RCT evidence |
What do semaglutide and cagrilintide cost?
| Dimension | Semaglutide | Cagrilintide |
|---|---|---|
| Typical cost | $149 to $1,349 per month | Not available through licensed channels. Products sold as research chemicals are not lawful for human use and are not verified for identity or purity. |
| Price detail | Semaglutide price by channel | Price index in progress |
Where a price index exists, the range is the cash price per month across branded, compounded, and telehealth channels, without insurance. The cost pages give each channel separately with its sources. Otherwise the typical cost from the peptide record is shown. Legal access depends on your state: see peptide legality by state.
Frequently asked questions
Is cagrilintide better than semaglutide for weight loss?
Not on its own. Cagrilintide alone produced 6.0% to 10.8% weight loss over 26 weeks in its phase 2 trial, while semaglutide 2.4 mg produced 14.9% over 68 weeks in STEP 1. Its value is as an add-on: combined with semaglutide it produced 20.4% weight loss in REDEFINE 1. [1] [3] [4]
What is CagriSema?
CagriSema is the investigational once weekly combination of cagrilintide 2.4 mg and semaglutide 2.4 mg. In REDEFINE 5 it produced 18.4% weight loss versus 11.9% for semaglutide alone at 68 weeks. It is not FDA approved as of the verification date. [4] [5]
Can I get cagrilintide from a compounding pharmacy?
No. Cagrilintide is not a component of an approved drug, has no USP monograph, and is not on the 503A bulks list, so pharmacies cannot lawfully compound it. The only lawful access is a registered clinical trial. [8]
Are athletes allowed to use either?
Semaglutide is not on the WADA Prohibited List. Cagrilintide is prohibited at all times under section S0 because it is not approved for human therapeutic use. [9]
Do they have the same side effects?
Both mainly cause gastrointestinal effects such as nausea, and adding cagrilintide to semaglutide increases them: gastrointestinal events affected 79.6% of people on the combination versus 39.9% on placebo in REDEFINE 1. Semaglutide also carries a thyroid C-cell tumor boxed warning. [3] [4] [6]
Conditions studied
From the blog
- Peptides for weight loss, ranked by human evidence
Tirzepatide, semaglutide, and liraglutide lead on human trials. Retatrutide is trial-only, and AOD-9604 and 5-amino-1MQ are animal-only. Ranking, legal status, and dated prices.
Sources
Numbered citations above point to these primary sources. PubMed entries link to the indexed abstract.
- [1]Wilding JPH et al. Once-weekly semaglutide in adults with overweight or obesity. N Engl J Med 2021 (STEP 1)PubMed 33567185, 2021
- [2]Lincoff AM et al. Semaglutide and cardiovascular outcomes in obesity without diabetes. N Engl J Med 2023 (SELECT)PubMed 37952131, 2023
- [3]Lau DCW et al. Once-weekly cagrilintide for weight management in people with overweight and obesity: a phase 2 trial. Lancet 2021PubMed 34798060, 2021
- [4]Garvey WT et al. Coadministered cagrilintide and semaglutide in adults with overweight or obesity. N Engl J Med 2025 (REDEFINE 1)PubMed 40544433, 2025
- [5]Yamauchi T et al. Co-administered cagrilintide and semaglutide versus semaglutide alone in adults with overweight or obesity in Japan and Taiwan (REDEFINE 5). Lancet Diabetes Endocrinol 2026PubMed 42009015, 2026
- [6]FDA prescribing information for Wegovy (semaglutide) injection, via DailyMedFDA
- [7]FDA: concerns with unapproved GLP-1 drugs used for weight loss, including shortage resolution and compounding deadlinesFDA
- [8]FDA: Bulk drug substances used in compounding under section 503A of the FD&C ActFDA
- [9]WADA Prohibited List, including section S0 non-approved substancesWADA
- [10]Manufacturer direct-to-patient pharmacy page with semaglutide self-pay prices, accessed 2026-09-22
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