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Compound monograph · evidence extract

CagriSema (cagrilintide with semaglutide) in type 2 diabetes mellitus — evidence extract

The Institute's graded assessment of CagriSema (cagrilintide with semaglutide) for type 2 diabetes mellitus, with the contributing trials and the domain-by-domain certainty reasoning.

Document identifier
CEI-MN-006/EV-T2DM
Series
Evidence extract
Version
4.1
Published
24 May 2024
Last reviewed
24 Feb 2025
Next review
24 Feb 2027
Identifier
10.71829/cei.mono.6
Certainty
Moderate
Cycle
2024 Q2

§1Evidence extract: Type 2 diabetes mellitus

§1.1Question and anchor outcome

Population
A disorder of glucose regulation characterised by insulin resistance with relative insulin deficiency, diagnosed by glycated haemoglobin, fasting plasma glucose or oral glucose tolerance criteria.
Intervention
CagriSema (cagrilintide with semaglutide), subcutaneous once weekly
Comparator
As used in each contributing trial; reported per trial rather than pooled across comparator types
Anchor outcome
Change in HbA1c (%, mmol/mol)

Additional outcomes the Institute extracts for this indication: Proportion achieving HbA1c <7.0 % and ≤6.5 %; Change in fasting serum glucose; Change in body weight; Documented symptomatic hypoglycaemia.

§1.2Contributing trials

Table 1. Trials contributing to the assessment of CagriSema (cagrilintide with semaglutide) in type 2 diabetes mellitus.

TrialPhaseDesignRandomisedDurationYear
REDEFINE-23Randomised, double-blind, placebo-controlled1,20668 weeks2025

§1.3Certainty assessment

Certainty assessment by domainDowngrading decision recorded for each certainty domain.Certainty domainNo concernSeriousVery seriousEffect on ratingRisk of biasno downgradeInconsistencyno downgradeIndirectnessdowngrade one levelImprecisionno downgradePublication biasno downgradeTotal downgrading: 1 levelModerate certainty
Figure 2. Domain-by-domain certainty assessment for CagriSema (cagrilintide with semaglutide) in type 2 diabetes mellitus. The starting rating for a body of randomised evidence is high; each serious concern reduces it by one level and each very serious concern by two.

Table 2. Reasoning recorded against each certainty domain.

DomainRatingReasoning
Risk of biasNo concernNo serious concern identified in this domain.
InconsistencyNo concernNo serious concern identified in this domain.
IndirectnessSeriousThe outcome is a surrogate whose relationship to the clinical outcome is unvalidated for this indication.
ImprecisionNo concernNo serious concern identified in this domain.
Publication biasNo concernNo serious concern identified in this domain.
Overall rating: Moderate certainty. The true effect is likely to be close to the estimate, but there is a possibility that it is substantially different. Further research is likely to have an important impact on confidence in the estimate.

§1.4What this extract does not establish

References cited on this page

References are numbered in order of first citation in this document. Each superscript in the text links to its entry below.

  1. Frías JP, Deenadayalan S, Erichsen L, Knop FK, Lingvay I, Macura S, Mathieu C, Pedersen SD, Davies M. Efficacy and safety of co-administered once-weekly cagrilintide 2·4 mg with once-weekly semaglutide 2·4 mg in type 2 diabetes: a multicentre, randomised, double-blind, active-controlled, phase 2 trial. The Lancet 2023;402(10403):720–730. doi:10.1016/S0140-6736(23)01163-7 · PMID 37364591
  2. Lau DCW, Erichsen L, Francisco AM, Satylganova A, le Roux CW, McGowan B, Pedersen SD, Pietiläinen KH, Rubino DM, Batterham RL. Once-weekly cagrilintide for weight management in people with overweight and obesity: a multicentre, randomised, double-blind, placebo-controlled and active-controlled, dose-finding phase 2 trial. The Lancet 2021;398(10317):2160–2172. doi:10.1016/S0140-6736(21)01751-7 · PMID 34798060
  3. Wilding JPH, Batterham RL, Calanna S, Davies M, Van Gaal LF, Lingvay I, McGowan BM, Rosenstock J, Tran MTD, Wadden TA, Wharton S, Yokote K, Zeuthen N, Kushner RF. Once-weekly semaglutide in adults with overweight or obesity. New England Journal of Medicine 2021;384(11):989–1002. doi:10.1056/NEJMoa2032183 · PMID 33567185

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