Development

Roche advances enicepatide toward Phase III after positive diabetes trial

Roche advances enicepatide toward Phase III after positive diabetes trial

Roche's (OTCQX: RHHBY) enicepatide, a once-weekly dual GLP-1/GIP receptor agonist, produced substantial reductions in both blood glucose and body weight in a Phase II trial in adults with type 2 diabetes (T2D) and overweight or obesity, adding glycemic data to a weight-loss profile that has already drawn comparisons to tirzepatide. Roche said it plans to initiate a Phase III glycemic-control program and cardiovascular outcomes trials in the first half of 2027.

The CT-388-104 study was a randomized, double-blind, placebo-controlled Phase II trial enrolling 447 adults with T2D and overweight or obesity, evaluating once-weekly subcutaneous enicepatide over 48 weeks. The trial carried dual primary endpoints of change from baseline in HbA1c and body weight at week 48, both of which were met, Roche reported.

Enicepatide, previously known as CT-388, was developed by Carmot Therapeutics and entered Roche’s pipeline through its January 2024 acquisition of the company, agreed at USD 2.7 billion upfront plus up to USD 400 million in milestones. The molecule activates both the GLP-1 and GIP receptors with minimal β-arrestin recruitment on either receptor, a biased signaling design intended to reduce receptor internalization and extend pharmacological activity relative to conventional incretin agonists.

For the 24mg dosage, mean HbA1c fell by 2.65 percentage points from a baseline of 8.1%, with 90% of patients on that 24mg dose reaching the T2D diagnostic threshold of ≤6.5% HbA1c and 62% achieving normoglycemia (HbA1c <5.7%). In the subgroup with poor baseline control (HbA1c >8.5%), the mean reduction was 4.13 percentage points. Mean weight loss at 48 weeks was 15.5%, with no plateau observed. The discontinuation rate due to adverse events was 2.0% in enicepatide arms versus 0.0% in the placebo arm, with gastrointestinal effects the most common adverse events, consistent with the incretin class.

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The T2D data extend a weight-loss profile established in the earlier CT388-103 Phase II study, where the 24 mg dose produced approximately 22.5% placebo-adjusted weight loss at 48 weeks in people with obesity or overweight without diabetes — a figure that compares favorably with tirzepatide's SURMOUNT data, though cross-trial comparisons are constrained by differences in population and design. Roche's most direct approved competitor is Eli Lilly's Zepbound/Moiunjaro (tirzepatide), which shares the dual GLP-1/GIP mechanism and once-weekly subcutaneous format.

Two Phase III chronic weight management trials, ENITH-1 and ENITH-2, are currently recruiting, and Roche said it plans to explore doses above 24 mg in Phase III following Q2 earnings disclosures indicating that 48% of patients at the highest dose achieved more than 20% weight loss. A Phase II combination study of enicepatide with petrelintide, a long-acting amylin analog developed with Zealand Pharma (Nasdaq: ZEAL), is also expected to initiate in H2 2026 under the ZYNERGY trial.


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