Cagrilintide

Last updated
Cagrilintide
Clinical data
Other namesGLXC-26801
Identifiers
  • 20-[[(1S)-4-[[(2S)-6-amino-1-[[(4R,7S,10S,13S,16S,19R)-4-[[(2S)-1-[[(2S,3R)-1-[[(2S)-5-amino-1-[[(2S)-1-[[(2S)-1-[[(2S)-1-[[(2S)-1-[[(2S)-1-[[(2S)-1-[[(2S)-1-[[(2S)-1-[[(2S)-1-[[(2S)-1-[[(2S)-4-amino-1-[[(2R)-4-amino-1-[[(2S)-1-[[2-[(2S)-2-[[(2S,3S)-1-[[(2S)-1-[(2S)-2-[(2S)-2-[[(2S,3R)-1-[[(2S)-4-amino-1-[[(2S)-1-[[2-[[(2S)-1-[[(2S)-4-amino-1-[[(2S,3R)-1-[(2S)-2-carbamoylpyrrolidin-1-yl]-3-hydroxy-1-oxobutan-2-yl]amino]-1,4-dioxobutan-2-yl]amino]-3-hydroxy-1-oxopropan-2-yl]amino]-2-oxoethyl]amino]-3-methyl-1-oxobutan-2-yl]amino]-1,4-dioxobutan-2-yl]amino]-3-hydroxy-1-oxobutan-2-yl]carbamoyl]pyrrolidine-1-carbonyl]pyrrolidin-1-yl]-4-methyl-1-oxopentan-2-yl]amino]-3-methyl-1-oxopentan-2-yl]carbamoyl]pyrrolidin-1-yl]-2-oxoethyl]amino]-1-oxo-3-phenylpropan-2-yl]amino]-1,4-dioxobutan-2-yl]amino]-1,4-dioxobutan-2-yl]amino]-3-hydroxy-1-oxopropan-2-yl]amino]-3-hydroxy-1-oxopropan-2-yl]amino]-3-(1H-imidazol-4-yl)-1-oxopropan-2-yl]amino]-5-carbamimidamido-1-oxopentan-2-yl]amino]-4-methyl-1-oxopentan-2-yl]amino]-1-oxo-3-phenylpropan-2-yl]amino]-4-carboxy-1-oxobutan-2-yl]amino]-1-oxopropan-2-yl]amino]-4-methyl-1-oxopentan-2-yl]amino]-5-carbamimidamido-1-oxopentan-2-yl]amino]-1,5-dioxopentan-2-yl]amino]-3-hydroxy-1-oxobutan-2-yl]amino]-1-oxopropan-2-yl]carbamoyl]-16-(2-amino-2-oxoethyl)-7,13-bis[(1R)-1-hydroxyethyl]-10-methyl-6,9,12,15,18-pentaoxo-1,2-dithia-5,8,11,14,17-pentazacycloicos-19-yl]amino]-1-oxohexan-2-yl]amino]-1-carboxy-4-oxobutyl]amino]-20-oxoicosanoic acid
CAS Number
PubChem CID
UNII
Chemical and physical data
3D model (JSmol)
  • CC[C@H](C)[C@@H](C(=O)N[C@@H](CC(C)C)C(=O)N1CCC[C@H]1C(=O)N2CCC[C@H]2C(=O)N[C@@H]([C@@H](C)O)C(=O)N[C@@H](CC(=O)N)C(=O)N[C@@H](C(C)C)C(=O)NCC(=O)N[C@@H](CO)C(=O)N[C@@H](CC(=O)N)C(=O)N[C@@H]([C@@H](C)O)C(=O)N3CCC[C@H]3C(=O)N)NC(=O)[C@@H]4CCCN4C(=O)CNC(=O)[C@H](CC5=CC=CC=C5)NC(=O)[C@@H](CC(=O)N)NC(=O)[C@H](CC(=O)N)NC(=O)[C@H](CO)NC(=O)[C@H](CO)NC(=O)[C@H](CC6=CNC=N6)NC(=O)[C@H](CCCNC(=N)N)NC(=O)[C@H](CC(C)C)NC(=O)[C@H](CC7=CC=CC=C7)NC(=O)[C@H](CCC(=O)O)NC(=O)[C@H](C)NC(=O)[C@H](CC(C)C)NC(=O)[C@H](CCCNC(=N)N)NC(=O)[C@H](CCC(=O)N)NC(=O)[C@H]([C@@H](C)O)NC(=O)[C@H](C)NC(=O)[C@@H]8CSSC[C@@H](C(=O)N[C@H](C(=O)N[C@H](C(=O)N[C@H](C(=O)N[C@H](C(=O)N8)[C@@H](C)O)C)[C@@H](C)O)CC(=O)N)NC(=O)[C@H](CCCCN)NC(=O)CC[C@@H](C(=O)O)NC(=O)CCCCCCCCCCCCCCCCCCC(=O)O
  • InChI=1S/C194H312N54O59S2/c1-19-100(10)151(184(298)233-128(78-98(6)7)189(303)248-75-49-60-137(248)190(304)247-74-48-59-136(247)182(296)243-155(107(17)255)187(301)232-127(86-143(201)262)173(287)238-150(99(8)9)183(297)210-88-146(265)218-129(90-249)176(290)230-126(85-142(200)261)175(289)244-156(108(18)256)191(305)246-73-46-57-134(246)157(202)271)239-181(295)135-58-47-72-245(135)147(266)89-211-161(275)120(79-109-50-36-34-37-51-109)225-171(285)123(82-139(197)258)228-172(286)124(83-140(198)259)229-177(291)130(91-250)235-178(292)131(92-251)234-170(284)122(81-111-87-207-95-212-111)227-164(278)114(56-45-71-209-194(205)206)221-168(282)119(77-97(4)5)224-169(283)121(80-110-52-38-35-39-53-110)226-166(280)116(65-68-149(269)270)219-158(272)101(11)213-167(281)118(76-96(2)3)223-163(277)113(55-44-70-208-193(203)204)220-165(279)115(63-66-138(196)257)222-186(300)153(105(15)253)240-159(273)102(12)214-179(293)132-93-308-309-94-133(180(294)231-125(84-141(199)260)174(288)242-152(104(14)252)185(299)215-103(13)160(274)241-154(106(16)254)188(302)237-132)236-162(276)112(54-42-43-69-195)216-145(264)67-64-117(192(306)307)217-144(263)61-40-32-30-28-26-24-22-20-21-23-25-27-29-31-33-41-62-148(267)268/h34-39,50-53,87,95-108,112-137,150-156,249-256H,19-33,40-49,54-86,88-94,195H2,1-18H3,(H2,196,257)(H2,197,258)(H2,198,259)(H2,199,260)(H2,200,261)(H2,201,262)(H2,202,271)(H,207,212)(H,210,297)(H,211,275)(H,213,281)(H,214,293)(H,215,299)(H,216,264)(H,217,263)(H,218,265)(H,219,272)(H,220,279)(H,221,282)(H,222,300)(H,223,277)(H,224,283)(H,225,285)(H,226,280)(H,227,278)(H,228,286)(H,229,291)(H,230,290)(H,231,294)(H,232,301)(H,233,298)(H,234,284)(H,235,292)(H,236,276)(H,237,302)(H,238,287)(H,239,295)(H,240,273)(H,241,274)(H,242,288)(H,243,296)(H,244,289)(H,267,268)(H,269,270)(H,306,307)(H4,203,204,208)(H4,205,206,209)/t100-,101-,102-,103-,104+,105+,106+,107+,108+,112-,113-,114-,115-,116-,117-,118-,119-,120-,121-,122-,123+,124-,125-,126-,127-,128-,129-,130-,131-,132-,133-,134-,135-,136-,137-,150-,151-,152-,153-,154-,155-,156-/m0/s1
  • Key:LDERDVMBIYGIOI-DDPFBLHVSA-N

Cagrilintide is a long-acting analogue of amylin. It is being tested to treat obesity and type 2 diabetes by itself and in combination with semaglutide as cagrilintide/semaglutide. [1] [2] [3] [4] [5] [6]

Related Research Articles

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<span class="mw-page-title-main">Amylin</span> Peptide hormone that plays a role in glycemic regulation

Amylin, or islet amyloid polypeptide (IAPP), is a 37-residue peptide hormone. It is co-secreted with insulin from the pancreatic β-cells in the ratio of approximately 100:1 (insulin:amylin). Amylin plays a role in glycemic regulation by slowing gastric emptying and promoting satiety, thereby preventing post-prandial spikes in blood glucose levels.

<span class="mw-page-title-main">Calcitonin receptor</span> Protein-coding gene in the species Homo sapiens

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<span class="mw-page-title-main">Liraglutide</span> Anti-diabetic medication

Liraglutide, sold under the brand names Victoza and Saxenda among others, is an anti-diabetic medication used to treat type 2 diabetes, and chronic obesity. It is a second-line therapy for diabetes following first-line therapy with metformin. Its effects on long-term health outcomes like heart disease and life expectancy are unclear. It is given by injection under the skin.

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<span class="mw-page-title-main">Semaglutide</span> Anti-diabetic and anti-obesity medication

Semaglutide is an antidiabetic medication used for the treatment of type 2 diabetes and an anti-obesity medication used for long-term weight management. It is a peptide similar to the hormone glucagon-like peptide-1 (GLP-1), modified with a side chain. It can be administered by subcutaneous injection or taken orally. It is sold under the brand names Ozempic and Rybelsus for diabetes, and under the brand name Wegovy for weight loss.

<span class="mw-page-title-main">Tirzepatide</span> Anti-diabetic medication

Tirzepatide, sold under the brand name Mounjaro among others, is an antidiabetic medication used for the treatment of type 2 diabetes and for weight loss. Tirzepatide is administered via subcutaneous injections.

Cagrilintide/semaglutide, marketed as CagriSema, is a combination of cagrilintide, a dual amylin and calcitonin receptor agonist, and semaglutide, a GLP-1 agonist. It is injected once weekly and is being tested in type 2 diabetes and obesity. Preliminary trial results found a greater weight loss compared to either medication alone. HbA1c was significantly improved compared to cagrilintide alone and non-significantly better than semaglutide alone. In a Phase II trial, weight loss averaged -15.6 percent after 32 weeks, making CagriSema comparable in efficacy to tirzepatide. A future trial sponsored by Novo Nordisk is comparing tirzepatide and CagriSema head-to-head. As of 2023, CagriSema is in a Phase III trial.

The amylin receptors (AMYRs) are heterodimers of the calcitonin receptor that are bound to by amylin with high affinity and consist of AMY1, AMY2, and AMY3. Amylin mimetics that are agonists at the amylin receptors are being developed as therapies for diabetes and obesity, and one, pramlintide, has been FDA approved. The AMY1 receptor may be activated by both amylin and the calcitonin gene-related peptide (CGRP) and could play a role in the effects of CGRP receptor antagonists developed for migraine. Dual agonists of the amylin and calcitonin receptors (DACRAs) are under development for obesity. Amylin and its receptors are believed to play a role in Alzheimer's disease.

Dual amylin and calcitonin receptor agonists (DACRAs) are a class of drugs that act as agonists at the amylin receptor and calcitonin receptor that are under development as therapies for obesity and type 2 diabetes. Examples are cagrilintide and the KBP family derived from salmon calcitonin, including KBP‐042, KBP-066A, KBP-089, and KBP-336.

Petrelintide is an amylin analogue dosed once weekly, developed by Zealand Pharma for the treatment of type 2 diabetes and obesity. Preclinical data suggests it may be more effective in combination with semaglutide.

GLP1 poly-agonist peptides are a class of drugs that activate multiple peptide hormone receptors including the glucagon-like peptide-1 (GLP-1) receptor. These drugs are developed for the same indications as GLP-1 receptor agonists—especially obesity, type 2 diabetes, and non-alcoholic fatty liver disease. They are expected to provide superior efficacy with fewer adverse effects compared to GLP-1 mono-agonists, which are dose-limited by gastrointestinal disturbances. The effectiveness of multi-receptor agonists could possibly equal or exceed that of bariatric surgery. The first such drug to receive approval is tirzepatide, a dual agonist of GLP-1 and GIP receptors.

References

  1. ↑ Larsen, Anna T.; Sonne, Nina; Mohamed, Khaled Elhady; Bredtoft, Emma-Marie; Andersen, Frederik; Karsdal, Morten A.; Henriksen, Kim (1 June 2022). "823-P: The Long-Acting Dual Amylin and Calcitonin Receptor Agonist KBP Has Increased Efficacy on Weight Loss and Glucose Control Compared with Cagrilintide in Obese and Diabetic Rats". Diabetes. 71 (Supplement_1). doi:10.2337/db22-823-P. S2CID   249259033.
  2. ↑ Lau, David C W; Erichsen, Lars; Francisco, Ann Marie; Satylganova, Altynai; le Roux, Carel W; McGowan, Barbara; Pedersen, Sue D; Pietiläinen, Kirsi H; Rubino, Domenica; Batterham, Rachel L (December 2021). "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. 398 (10317): 2160–2172. doi:10.1016/S0140-6736(21)01751-7. PMID   34798060. S2CID   244169045.
  3. ↑ Kruse, Thomas; Hansen, Jakob Lerche; Dahl, Kirsten; Schäffer, Lauge; Sensfuss, Ulrich; Poulsen, Christian; Schlein, Morten; Hansen, Ann Maria Kruse; Jeppesen, Claus Bekker; Dornonville de la Cour, Charlotta; Clausen, Trine Ryberg; Johansson, Eva; Fulle, Simone; Skyggebjerg, Rikke Bjerring; Raun, Kirsten (12 August 2021). "Development of Cagrilintide, a Long-Acting Amylin Analogue". Journal of Medicinal Chemistry. 64 (15): 11183–11194. doi:10.1021/acs.jmedchem.1c00565. ISSN   0022-2623. PMID   34288673. S2CID   236175929.
  4. ↑ Frias, Juan P; Deenadayalan, Srikanth; Erichsen, Lars; Knop, Filip K; Lingvay, Ildiko; Macura, Stanislava; Mathieu, Chantal; Pedersen, Sue D; Davies, Melanie (August 2023). "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. 402 (10403): 720–730. doi:10.1016/S0140-6736(23)01163-7. PMID   37364590. S2CID   259237278.
  5. ↑ D’Ascanio, Antonella M.; Mullally, Jamie A.; Frishman, William H. (8 March 2023). "Cagrilintide: A Long-Acting Amylin Analog for the Treatment of Obesity". Cardiology in Review. Publish Ahead of Print. doi:10.1097/CRD.0000000000000513. PMID   36883831. S2CID   257404657.
  6. ↑ Larsen, A. T.; Mohamed, K. E.; Sonne, N.; Bredtoft, E.; Andersen, F.; Karsdal, MA; Henriksen, K. (1 December 2022). "Does receptor balance matter? – Comparing the efficacies of the dual amylin and calcitonin receptor agonists cagrilintide and KBP-336 on metabolic parameters in preclinical models". Biomedicine & Pharmacotherapy. 156: 113842. doi: 10.1016/j.biopha.2022.113842 . ISSN   0753-3322. PMID   36242844. S2CID   252881350.


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