Novo Nordisk CagriSema data shows brain, organ and bone effects
Novo Nordisk has presented a trio of late-breaking studies at the European Association for the Study of Diabetes (EASD) Annual Meeting 2026, each examining how its investigational fixed-dose combination CagriSema acts on biological systems beyond simple weight reduction. The data extend the mechanistic picture for a drug that already has a New Drug Application under FDA review for obesity, with a decision expected in the fourth quarter of 2026.
CagriSema pairs cagrilintide, a long-acting amylin receptor agonist, with semaglutide, the GLP-1 receptor agonist already widely used as Ozempic and Wegovy. The amylin component has drawn particular scientific interest for its potential to act on appetite-regulating circuits in the brain, and the EASD data provide the first substantial neuroimaging evidence in support of that hypothesis.
Brain and behaviour: the fMRI findings
In a 52-week functional MRI study in adults with overweight or obesity, CagriSema modified brain responses to high-calorie food images in regions associated with cravings, reward processing, sensory evaluation, and behavioural inhibition. Participants also reported meaningful reductions in what researchers and patients commonly call "food noise": persistent, intrusive thoughts about eating. The changes were observed at both 22 and 52 weeks, suggesting they are sustained rather than transient. The study, which received a Best Abstract Award at EASD 2026, reported a 22.4% reduction in body weight versus placebo at 52 weeks (estimated treatment difference, p<0.0001).
Professor Tony Goldstone, clinical professor in psychoneuroendocrinology at Imperial College London, said the results showed "substantially reduced food cravings and sustained changes in the brain response to viewing pictures of high-calorie foods" across all measures of appetite and eating behaviour after a year of treatment, alongside reduced energy intake.
Organ fat and bone: the REIMAGINE sub-studies
A second study, an MRI sub-study nested within the phase 3a REIMAGINE 1 trial in adults with early type 2 diabetes, found that CagriSema 2.4 mg/2.4 mg produced significant reductions in ectopic fat, specifically fat around and within the liver and pancreas, versus placebo, alongside a 14.3% body-weight reduction at week 40. Ectopic fat in these organs is a recognised driver of insulin resistance and metabolic dysfunction.
A post hoc analysis of bone biomarker data from the phase 3 REIMAGINE 2 trial adds a further dimension. At week 68, with a 14.2% body-weight reduction on CagriSema 2.4 mg/2.4 mg, bone markers indicated what the study authors described as a healthy balance in bone maintenance, providing what they called "preliminary reassurance" regarding bone remodelling. Weight loss therapies have historically raised concerns about accelerated bone loss, making this signal commercially and clinically relevant, even though the analysis is post hoc and therefore exploratory.
Market and competitive context
The incretin and obesity pharmacology market has expanded rapidly since the approval of tirzepatide and high-dose semaglutide, and mechanistic differentiation has become a central competitive axis. Eli Lilly's tirzepatide (a dual GIP/GLP-1 agonist) and Novo's own semaglutide products remain the dominant approved treatments; several pipeline candidates from companies including Amgen, Structure Therapeutics, and Viking Therapeutics are pursuing the next generation of weight-loss agents.
CagriSema's amylin-plus-GLP-1 mechanism is substantively different from either GIP/GLP-1 or GLP-1 monotherapy, and the neuroimaging and organ-fat data presented at EASD 2026 are designed to frame that distinction as clinically meaningful rather than merely pharmacological. Whether the FDA will view the "food noise" and ectopic-fat data as label-worthy claims remains to be seen; the agency's forthcoming decision on the obesity NDA filed in December 2025 will be the immediate catalyst.
Martin Holst Lange, executive vice president and chief scientific officer at Novo Nordisk, said the EASD data "add to emerging evidence that the amylin component of CagriSema may influence disease biology across the brain and multiple organs beyond weight loss alone."
A high-dose formulation, CagriSema 2.4 mg/7.2 mg, entered a new phase 3 efficacy and safety trial in adults with obesity in 2026, extending the development programme further.