CagriSema vs tirzepatide (Zepbound): trial results

Which is better, tirzepatide or cagrilintide?

Tirzepatide is the only one that can be prescribed today and has cardiovascular outcomes data (SURPASS-CVOT). The combination of cagrilintide and semaglutide came close to it in a 2026 network meta-analysis but fell short of tirzepatide 15 mg in the direct REDEFINE 4 trial and beat the 5 mg tirzepatide dose in REIMAGINE 5, but that trial has not been published and the combination is still under FDA review. Cagrilintide alone is far less effective than tirzepatide. [1] [2] [3] [4] [5] [6] [12]

How do tirzepatide and cagrilintide compare?

Tirzepatide and Cagrilintide compared by dimension
Dimension	TirzepatideFavored	Cagrilintide
Mechanism [6] [7] [8]	Dual GIP and GLP-1 receptor agonist.	Long acting amylin analog; developed mainly as a fixed combination with the GLP-1 agonist semaglutide.
Weight loss evidence [1] [6] [8]	15.0%, 19.5%, and 20.9% at 5, 10, and 15 mg versus 3.1% on placebo at 72 weeks (SURMOUNT-1).	Alone: 10.8% at 4.5 mg versus 3.0% on placebo at 26 weeks. With semaglutide 2.4 mg: 20.4% versus 3.0% at 68 weeks (REDEFINE 1).
Direct comparison [4]	Tirzepatide 5 mg in REIMAGINE 5: 9.1% weight loss and HbA1c minus 1.67 points at 60 weeks in type 2 diabetes.	Cagrilintide plus semaglutide 1.0 mg each in REIMAGINE 5: 12.4% weight loss (superior) and HbA1c minus 1.71 points (noninferior).
Note: Topline results announced by the manufacturer on September 21, 2026; not yet published in a journal, and the trial used the lowest tirzepatide maintenance dose.
Network meta-analysis [3]	Mean difference versus lifestyle at one year minus 14.9% (moderate to high certainty); reduced heart failure risk.	Combination with semaglutide minus 14.8%; among the highest rates of discontinuation for adverse events and increased fatigue risk.
Cardiovascular outcomes [2] [8]	SURPASS-CVOT: noninferior to dulaglutide (hazard ratio 0.92) in 13,165 analyzed adults with type 2 diabetes and heart disease.	No cardiovascular outcomes trial has reported.
Regulatory status [5] [7] [9]	FDA approved (Mounjaro 2022, Zepbound 2023).	Not FDA approved alone or in combination; a new drug application for cagrilintide 2.4 mg plus semaglutide 2.4 mg was submitted in December 2025. Not eligible for compounding.
WADA status [10]	Not on the WADA Prohibited List.	Prohibited under section S0 while not approved by any regulator.
Cost and access [9] [11]	Manufacturer self-pay for the KwikPen starts at 299 USD per 28 days at 2.5 mg; commercial savings card from 25 USD for a covered fill (checked 2026-09-22).	No lawful purchase channel outside clinical trials.

Evidence grade and regulatory status

Pulled from each peptide’s own record, so it stays in step with the peptide pages.

Tirzepatide and Cagrilintide: grade, status, and cost
Attribute	Tirzepatide	Cagrilintide
Class	Dual GIP and GLP-1 receptor agonist (39 amino acid peptide, 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 weekly GIP and GLP-1 drug with 20.9% average weight loss at 15 mg in a 72 week randomized trial; beat semaglutide head to head.	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 (Mounjaro May 2022, Zepbound November 2023). FDA declared the tirzepatide shortage resolved on December 19, 2024; compounding by 503A pharmacies had to stop by February 18, 2025 and by 503B outsourcing facilities by March 19, 2025, except for a documented patient specific clinical need. FDA has warned about unapproved compounded and counterfeit tirzepatide products. On April 30, 2026 FDA proposed not to include tirzepatide 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 (pen or single dose vial)	Subcutaneous injection once weekly (clinical trials only)
Typical cost	Manufacturer list price is up to 1,086.37 USD per fill for Zepbound and 1,112.16 USD for Mounjaro (checked 2026-09-22). Manufacturer self-pay Zepbound vials and KwikPen cost 299 USD per month at 2.5 mg, 399 at 5 mg, 499 at 7.5 mg, and 699 at 10 mg and above, with a 449 USD on-time refill offer for the 7.5 mg and higher KwikPen through 2026. With commercial insurance a savings card can bring a covered prescription to 25 USD, and eligible Medicare Part D enrollees pay 50 USD per month for the Zepbound KwikPen under the Medicare GLP-1 Bridge (July 2026 to December 2027). A study published in 2025 found compounded tirzepatide advertised at a median 330 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	Sep 27, 2026	Sep 27, 2026

Has tirzepatide been tested directly against cagrilintide?

No published trial has compared tirzepatide and cagrilintide directly. The dimensions above come from separate studies and labels, and cross-trial comparisons are less reliable than a direct trial.

What do tirzepatide and cagrilintide cost?

Typical cost of Tirzepatide and Cagrilintide
Dimension	Tirzepatide	Cagrilintide
Typical cost	$275 to $1,112 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	Tirzepatide 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 CagriSema better than tirzepatide?

In REIMAGINE 5, cagrilintide plus semaglutide at 1.0 mg each produced 12.4% weight loss versus 9.1% with tirzepatide 5 mg at 60 weeks in type 2 diabetes, per the manufacturer's topline release. A 2026 network meta-analysis estimated nearly identical one year weight loss (14.8% versus 14.9% beyond lifestyle), but in REDEFINE 4, an open label 84 week trial in 809 adults with obesity and at least one related condition, cagrilintide plus semaglutide 2.4 mg each produced 23.0% weight loss versus 25.5% with tirzepatide 15 mg (efficacy estimand; 20.2% versus 23.6% by treatment regimen estimand) and did not meet its goal of showing non-inferiority to tirzepatide, per the manufacturer's topline release (not yet peer reviewed). [3] [4] [12]

How much weight loss does cagrilintide cause by itself?

10.8% at the 4.5 mg dose over 26 weeks in its phase 2 trial, about half of what tirzepatide 15 mg produced over 72 weeks in SURMOUNT-1. [1] [6]

Is the cagrilintide and semaglutide combination approved?

Not on the verification date. The manufacturer submitted a new drug application to FDA in December 2025. [5]

Which one is more likely to be stopped for side effects?

In the 2026 network meta-analysis, the cagrilintide and semaglutide combination was among the drugs with the highest discontinuation for adverse events, while tirzepatide was among those with the most gastrointestinal events. [3]

Conditions studied

Sources

Numbered citations above point to these primary sources. PubMed entries link to the indexed abstract.

Cite this page

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APA style: PeptideAgent. (2026, September 27). Tirzepatide vs cagrilintide: evidence, cost, and legality. https://peptideagent.ai/compare/tirzepatide-vs-cagrilintide
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Cagrilintide and CagriSema vs tirzepatide (Zepbound)

The short answer