SNAPSHOT

Novo’s CagriSema pulls ahead of Wegovy in diabetes trial but Lilly’s Zepbound still leads the pack

Novo Nordisk said its experimental obesity-and-diabetes shot CagriSema lowered blood sugar and body weight more than its own best-selling drug Wegovy/Ozempic in a Phase 3 trial of people with Type 2 diabetes and obesity.

Why it matters: The results bolster Novo’s bid for regulatory approval and intensify competition with Eli Lilly, whose Zepbound has become the world’s top-selling obesity drug.

Backstory: CagriSema combines semaglutide (the active ingredient in Wegovy and Ozempic) with cagrilintide, an amylin-based drug aimed at enhancing metabolic effects. Novo has already asked the FDA to approve CagriSema for obesity, even as earlier trial data fell short of its own expectations.

Big picture: Obesity and diabetes treatments are one of the most lucrative and competitive areas in pharma right now. While incremental gains matter, head-to-head comparisons and real-world effectiveness are increasingly shaping which drugs dominate the market.

Zoom in: The trial enrolled more than 2,700 people with Type 2 diabetes who were overweight or obese. Among participants who completed 68 weeks of treatment, CagriSema cut blood sugar by 1.9 percentage points and body weight by 14%, versus 1.8 points and 10% for Wegovy. Using a more conservative “treatment-regimen estimand” that includes dropouts and treatment changes, CagriSema reduced blood sugar by 1.8 points and weight by 13%, compared with 1.7 points and 9% for Wegovy. This still manages to be beaten by Lilly’s Zepbound in similar trials, which achieved about a 2.1-point blood sugar reduction and nearly 15% weight loss at its highest dose.

What’s next: Novo has revamped its CagriSema program, extending trial lengths and adjusting dosing strategies, to squeeze out more efficacy after early disappointments, raising the stakes for the upcoming Lilly showdown. A pivotal head-to-head obesity trial comparing CagriSema directly with Zepbound is expected to report results by the end of March. But as you will see in today’s Snippets, the competition still rages with other challengers to the throne.

SNIPPETS

What’s happening in biotech today?

👍 More obesity news: Pfizer reported phase 2b data showing that its GLP-1 receptor agonist PF-08653944 (formerly MET-097i) achieved competitive weight loss when patients switched from weekly to monthly dosing, supporting the company’s $10 billion acquisition of Metsera. In the Vesper-3 trial of about 250 adults with obesity or overweight, low and medium monthly maintenance doses produced placebo-adjusted weight loss of 10% and 12.3% at 28 weeks, with continued loss and no plateau. Safety was generally manageable, with mostly mild to moderate gastrointestinal events. Pfizer plans higher doses and extensive phase 3 studies as it targets a 2028 launch to offset looming patent expirations.

🔄 And another one: Skye Bioscience reported 52-week extension data showing its peripherally restricted CB1 inhibitor nimacimab achieved 22.3% total weight loss when combined with semaglutide (the drug from Novo that we mentioned in today’s Snapshot), despite the underlying phase 2 trial failing its primary endpoint at 26 weeks. In the extension, patients continuing nimacimab plus semaglutide saw weight loss rise from 14.4% at Week 26 to 22.3% at Week 52, compared with 19.7% on semaglutide alone, with no plateau observed. Patients who discontinued treatment regained more weight in the control group than in the nimacimab group. No serious or neuropsychiatric safety issues emerged. Skye plans higher-dose studies and aims to enter phase 2b in 2026.

💰 IPO window: Exxel Pharma has filed to raise about $13.2 million in an IPO on the NYSE American to fund early clinical development of EX937, a peripherally restricted FAAH inhibitor aimed at refractory chronic cough and related hypersensitivity disorders. Proceeds would support manufacturing and a planned phase 1 trial in Australia this year. FAAH inhibitors have a troubled history, including serious safety events and clinical failures, but Exxel argues EX937 avoids past pitfalls by being excluded from the central nervous system, potentially reducing side effects. The company also holds rights to additional FAAH compounds while prioritizing EX937, and currently operates with a very small, largely part-time leadership team.

❌ Endpoint miss: NMD Pharma’s phase 2a trial of ignaseclant in Charcot-Marie-Tooth disease missed its primary endpoint, showing no significant improvement on the six-minute walk test versus placebo after 21 days. However, the biotech is accelerating development based on prespecified secondary endpoints that indicated consistent, clinically meaningful gains in muscle strength, motor performance and patient-reported outcomes. Benefits appeared early, did not plateau by the end of dosing and persisted after treatment stopped, suggesting effects beyond short-term muscle activation. The drug was well tolerated with no serious adverse events. Encouraged by the secondary data and unmet need in CMT, NMD plans further development while also advancing ignaseclant in other neuromuscular indications.

🎯 Autoimmune target: WuXi Biologics has entered a license and research services agreement with Vertex Pharmaceuticals for a preclinical trispecific T-cell engager targeting B-cell–mediated autoimmune diseases. Under the deal, Vertex receives exclusive global rights to develop and commercialize the program, while WuXi is eligible for an upfront payment, development, regulatory and sales milestones, and royalties, although financial details were not disclosed. WuXi will also support discovery and development of next-generation immune engagers. The molecule was discovered using WuXi’s internal platforms and remains preclinical. For Vertex, the agreement expands its early-stage immunology pipeline beyond its core cystic fibrosis franchise.

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