cotadutide (MEDI0382) / AstraZeneca - LARVOL DELTA

Systemic Pharmacokinetic Principles of Therapeutic Peptides. (PubMed, Clin Pharmacokinet) - "In summary, our results underscore that the systemic pharmacokinetics of peptide drugs generally follow size-related physiological scaling patterns and provide quantitative tools to facilitate translational assessments in the drug discovery process."

Journal • PK/PD data

Glycemic control, weight-loss effects, and safety of cotadutide in individuals with type 2 diabetes: A systematic review and meta-analysis. (PubMed, World J Diabetes) - "Cotadutide demonstrated glycemic control and weight-loss benefits in short-term, small RCTs (mostly phase 2). However, small sample sizes, very low to low certainty of evidence, and the absence of data on long-term cardiovascular and renal outcomes highlight substantial uncertainties, warranting cautious interpretation and further investigation in larger, longer-term trials to establish its safety and efficacy profile."

Journal • Retrospective data • Cardiovascular • Constipation • Diabetes • Dyspepsia • Gastroenterology • Gastrointestinal Disorder • Genetic Disorders • Metabolic Disorders • Obesity • Type 2 Diabetes Mellitus

Comparative Analysis of Glucagon Receptor Agonists vs. Resmetirom in MASLD and MASH: Network Meta-Analysis of Clinical Trials. (PubMed, Endocrinol Diabetes Metab) - "GRAs superiorly reduce ALT levels, MRI-PDFF, and ELF. Resmetirom significantly reduces AST, HDL, and LDL levels, increases MASH resolution without worsening of fibrosis, and offers a more favourable safety profile. Both GRAs and resmetirom significantly increase adiponectin."

Clinical • Journal • Retrospective data • Review • Fatigue • Fibrosis • Immunology • Metabolic Dysfunction-Associated Steatohepatitis • Metabolic Dysfunction-Associated Steatotic Liver Disease

Co-Administration of GLP-1R/GCGR and Amylin Receptor Agonists Improves Body Weight in DIO Rats (OBESITY WEEK 2025) - "We aimed to evaluate the combination effects of AZD6234 and the GLP-1R/GCGR agonist cotadutide (cota) on BW gain in obese (DIO) rats, and acute effects on GE in chow fed rats. DIO rats treated with a combination of AZD6234 and cota displayed an additive effect on decreasing BW gain vs. monotherapy accompanied by a decrease in peri-renal fat pad and liver weights. Treatment with AZD6234 or cota showed an expected decrease in GE in dose-dependent manner, and an additional effect on GE was observed with combination treatment at sub-maximal doses as compared to monotherapy."

Preclinical • Genetic Disorders • Obesity

Weight Loss, Obesity Medication, and Risk of Obesity-Associated Cancer: A Meta-Analysis of Randomized Controlled Trials. (PubMed, Obesity (Silver Spring)) - "Weight reduction mediated by current AOMs was not associated with a reduced risk of overall or site-specific obesity-associated cancer in patients with overweight or obesity, while a decreased risk of overall obesity-associated cancer was observed in coagonist users."

Journal • Retrospective data • Review • Genetic Disorders • Obesity • Oncology

COMPARATIVE EVALUATION OF GLUCAGON-LIKE PEPTIDE-1 RECEPTOR AGONISTS AND THEIR ASSOCIATION WITH THE RISK OF ASTHMA INCIDENCE: A COMPREHENSIVE BAYESIAN NETWORK META-ANALYSIS (CHEST 2025) - "For the reduction of asthma incidence, Semaglutide ranked highest (RR: 0.20, 95% CrI: 0.01 to 2.08; SUCRA: 84.83%), compared to Control (SUCRA: 44.9%), with Liraglutide ranked second (RR: 0.55, 95% CrI: 0.08 to 4.07; SUCRA: 64.4%). Other interventions included Exenatide (RR: 0.56, 95% CrI: 0.07 to 4.57; SUCRA: 63.57%), Lixisenatide (RR: 0.56, 95% CrI: 0.06 to 5.00; SUCRA: 63.08%), Cotadutide (RR: 0.81, 95% CrI: 0.05 to 39.67; SUCRA: 50.67%), Efpeglenatide (RR: 1.08, 95% CrI: 0.09 to 16.37; SUCRA: 43.95%), Dulaglutide (RR: 1.52, 95% CrI: 0.20 to 11.46; SUCRA: 32.65%), Albiglutide (RR: 1.77, 95% CrI: 0.24 to 12.90; SUCRA: 28.16%) and Tirzepatide (RR: 2.81, 95% CrI: 0.18– 115.35; SUCRA: 23.77%)... In conclusion, our Bayesian network meta-analysis demonstrates that Semaglutide is the most effective GLP-1 receptor agonist in reducing asthma incidence in patients with type 2 diabetes. In contrast, Tirzepatide and Albiglutide were associated with an increased risk of asthma...."

Retrospective data • Asthma • Diabetes • Immunology • Inflammation • Metabolic Disorders • Respiratory Diseases • Type 2 Diabetes Mellitus

TURNING THE TIDE ON FATTY LIVER: EFFICACY AND SAFETY OF GLP-1 RECEPTOR AGONISTS IN THE TREATMENT OF METABOLIC DYSFUNCTION-ASSOCIATED STEATOTIC LIVER DISEASE AND STEATOHEPATITIS – A SYSTEMATIC REVIEW (AASLD 2025) - "Cotadutide produced greater weight loss than liraglutide. GLP-1 receptor agonists, particularly semaglutide, offer significant benefits in reducing hepatic fat, resolving MASH, and improving cardiometabolic parameters in MASLD/MASH patients, especially those with early-stage fibrosis. Their safety profile is favorable, with manageable gastrointestinal side effects. While benefits in advanced fibrosis are limited, GLP-1 RAs are poised to become a cornerstone in the management of MASLD/MASH, especially for patients with metabolic comorbidities."

Clinical • Review • Cardiovascular • Diabetes • Fibrosis • Genetic Disorders • Hepatology • Immunology • Metabolic Disorders • Metabolic Dysfunction-Associated Steatohepatitis • Metabolic Dysfunction-Associated Steatotic Liver Disease • Obesity • Type 2 Diabetes Mellitus

SAFETY AND EFFICACY OF COTADUTIDE, A DUAL GLP-1 AND GLUCAGON RECEPTOR AGONIST IN ADULTS WITH NON-CIRRHOTIC METABOLIC DYSFUNCTION-ASSOCIATED STEATOHEPATITIS WITH FIBROSIS: FINAL RESULTS: FROM A PHASE IIB RANDOMIZED, PLACEBO-CONTROLLED, PROOF-OF CONCEPT STUDY (AASLD 2025) - "Cotadutide 300 μg and 600 μg showed safety and tolerability consistent with its known profile in adults with non-cirrhotic MASH with fibrosis. Numerical improvements in MASH resolution were observed without worsening of liver fibrosis. Compared to placebo, a higher proportion in the Cotadutide 600 μg group experienced liver fibrosis improvement without MASH deterioration."

Clinical • P2b data • Fibrosis • Hepatology • Immunology • Inflammation • Liver Cirrhosis • Metabolic Disorders • Metabolic Dysfunction-Associated Steatohepatitis

Efficacy of Dual Glucagon and Glucagon-like Peptide-1 Receptor Agonists Across the Cardiometabolic Continuum: A Review of Current Clinical Evidence. (PubMed, Rev Cardiovasc Med) - "Emerging clinical evidence on agents such as survodutide and cotadutide has revealed striking improvements in glycated hemoglobin (HbA1c) levels and body weight, consistently outperforming traditional GLP-1 receptor agonists. This review highlights the transformative potential of dual GLP-1/Gcg receptor agonists, providing a thorough examination of their mechanisms of action, clinical efficacy, and safety profiles across the cardio-metabolic continuum. As the limitations of existing therapies become increasingly evident, these next-generation agents are poised to redefine the standard of care across the cardiometabolic continuum, ushering in a new era of precision medicine for metabolic disease."

Journal • Review • Cardiovascular • Diabetes • Genetic Disorders • Hepatology • Metabolic Disorders • Metabolic Dysfunction-Associated Steatotic Liver Disease • Obesity • Type 2 Diabetes Mellitus • GCG

Comparative Analysis of Glucagon Receptor Agonists vs Resmetirom in MASLD and MASH:Network Meta-Analysis of Clinical Trials (ENDO 2025) - "Resmetirom, a thyroid hormone receptor-β agonist, and glucagon receptor agonists (GRAs), such as Cotadutide, Retatrutide, and Survodutide, have demonstrated potential efficacy in recent clinical trials. SAE risk was not significantly elevated for Resmetirom (RR: 1.11, 95% CI: [0.77; 1.59], p = 0.58), but GRAs showed a trend toward higher SAE rates (RR: 2.38, 95% CI: [0.98; 5.82], p = 0.056).ConclusionsBoth Resmetirom and GRAs effectively reduce liver fat and ALT levels in MASLD/MASH patients, with Resmetirom offering a favorable safety profile and GRAs demonstrating superior ALT reductions but a potential increase in SAE risk. These findings underscore the promise of both therapeutic classes and highlight the need for further comparative trials to inform treatment decisions."

Retrospective data • Fibrosis • Genetic Disorders • Hepatocellular Cancer • Hepatology • Immunology • Metabolic Dysfunction-Associated Steatohepatitis • Metabolic Dysfunction-Associated Steatotic Liver Disease • Obesity • Oncology • Solid Tumor

Comparative Analysis of Glucagon Receptor Agonists vs Resmetirom in MASLD and MASH:Network Meta-Analysis of Clinical Trials (ENDO 2025) - "Resmetirom, a thyroid hormone receptor-β agonist, and glucagon receptor agonists (GRAs), such as Cotadutide, Retatrutide, and Survodutide, have demonstrated potential efficacy in recent clinical trials. SAE risk was not significantly elevated for Resmetirom (RR: 1.11, 95% CI: [0.77; 1.59], p = 0.58), but GRAs showed a trend toward higher SAE rates (RR: 2.38, 95% CI: [0.98; 5.82], p = 0.056).ConclusionsBoth Resmetirom and GRAs effectively reduce liver fat and ALT levels in MASLD/MASH patients, with Resmetirom offering a favorable safety profile and GRAs demonstrating superior ALT reductions but a potential increase in SAE risk. These findings underscore the promise of both therapeutic classes and highlight the need for further comparative trials to inform treatment decisions."

Retrospective data • Fibrosis • Genetic Disorders • Hepatocellular Cancer • Hepatology • Immunology • Metabolic Dysfunction-Associated Steatohepatitis • Metabolic Dysfunction-Associated Steatotic Liver Disease • Obesity • Oncology • Solid Tumor

Comparative Efficacy and Safety of Glucagon Receptor Agonists in Metabolic Outcomes: A Network Meta-Analysis of Randomized Controlled Trials (ENDO 2025) - "Retatrutide and survodutide demonstrate superior efficacy in weight loss and glycemic control among glucagon receptor agonists, though at the cost of higher adverse event-related discontinuation."

Retrospective data • Cardiovascular • Diabetes • Genetic Disorders • Metabolic Disorders • Obesity • Type 2 Diabetes Mellitus

From In Vitro Efficacy to Long-Term HbA1c Response for GLP-1R/GlucagonR Agonism Using the 4GI-HbA1c Systems Model. (PubMed, CPT Pharmacometrics Syst Pharmacol) - "Retrospective analysis showed that the model adequately predicted the effect of cotadutide and liraglutide on fasting plasma glucose and HbA1c (Root Means Square Percent Error (RMSPE) 5.9% and 13%, respectively). This demonstrates the potential of the 4GI-HbA1c systems model as a valuable tool in supporting the clinical development of novel GLP-1 and/or glucagon agonists."

Journal • Preclinical • Diabetes • Metabolic Disorders • Type 2 Diabetes Mellitus

Beyond GLP-1: efficacy and safety of dual and triple incretin agonists in personalized type 2 diabetes care-a systematic review and network meta-analysis. (PubMed, Acta Diabetol) - "Receptor-specific targeting optimizes T2DM treatment, with Semaglutide supporting glycemic control, Tirzepatide enhancing weight loss and glucose regulation, and Retatrutide potentially offering broader metabolic benefits, advancing receptor-targeted, personalized therapy."

Journal • Retrospective data • Review • Diabetes • Metabolic Disorders • Type 2 Diabetes Mellitus

GLP-1R/GCGR dual agonism dissipates hepatic steatosis to restore insulin sensitivity and rescue pancreatic β-cell function in obese male mice. (PubMed, Nat Commun) - "Here, we utilize cotadutide, a well characterized GLP-1R/GCGR dual-agonist, and demonstrate improvement of insulin sensitivity during hyperinsulinemic euglycemic clamp following sub-chronic dosing in male, diet-induced obese (DIO) mice...Here we show, GLP-1R/GCGR dual agonism provides multimodal efficacy to decrease hepatic steatosis and consequently improve insulin sensitivity, in concert with recovery of endogenous β-cell function and reduced insulin demand. This substantiates GLP-1R/GCGR dual-agonism as a potentially effective T2D treatment."

Journal • Preclinical • Diabetes • Metabolic Disorders • Obesity • Type 2 Diabetes Mellitus

Pharmacokinetic-pharmacodynamic (PK/PD) modelling of cotadutide effect in patients with chronic kidney disease and type 2 diabetes mellitus. (PubMed, Br J Clin Pharmacol) - P2 | "This modelling assessment was successfully applied for cotadutide to understand the relationship between cotadutide dosing regimen and the response in UACR, UALB and body weight. These models have general application in analysing and interpreting data from CKD/diabetic kidney disease (DKD) studies."

Journal • PK/PD data • Chronic Kidney Disease • Diabetes • Diabetic Nephropathy • Metabolic Disorders • Nephrology • Renal Disease • Type 2 Diabetes Mellitus

Comparative Effectiveness of Semaglutide, Liraglutide, Orlistat, and Phentermine for Weight Loss in Obese Individuals: A Systematic Review. (PubMed, Cureus) - "This literature review evaluates and compares the effectiveness of four pharmacological agents semaglutide, liraglutide, orlistat, phentermine, and emerging agents like setmelanotide, amycretin, retatrutide, cagrilintide, and cotadutide in managing weight loss among obese. A detailed analysis was conducted on their mechanisms of action, dosing regimens, efficacy in weight loss, safety profiles, and their impact on obesity-related comorbidities. Although all agents presented distinct benefits, side effects such as gastrointestinal discomfort with orlistat and GLP-1 receptor agonists, and potential dependency with phentermine, necessitate tailored treatment approaches. This review highlights the importance of integrating pharmacotherapy with lifestyle interventions to achieve sustainable weight management and identifies areas for future research to optimize therapeutic outcomes for individuals with obesity."

HEOR • Journal • Review • Cardiovascular • Gastrointestinal Disorder • Genetic Disorders • Obesity

Potential New Treatments for Chronic Kidney Diseases: A Concise Review. (PubMed, Curr Pharm Des) - "This concise review will shed light on the clinical trials of runcaciguat, cotadutide, osocimab, and Endothelin Receptor Antagonists (ERAs) in patients with CKD and/or ESKD. These drugs were retrieved following surveying the Clinical Trial database as well as the Pubmed database, both maintained by the US National Library of Medicine."

Journal • Cardiovascular • Chronic Kidney Disease • Diabetes • Hypertension • Metabolic Disorders • Nephrology • Renal Disease • Transplantation

Cotadutide reversible self-assembly based long-acting injectable depot for sustained delivery of GLP-1 glucagon receptor agonists with controlled burst release. (PubMed, J Control Release) - "This extended-release formulation also maintains smaller peak and trough fluctuation within therapeutic window, and PK modelling of repeated dose indicates this formulation could enable a possible dose frequency of 14 days in rat with assumed therapeutic concentration (ratios of the maximum concentration and the trough concentration) Cmax/Ctrough window. This new long-acting injectable (LAI) method could open the door to transforming short-life peptides with sub-optimal half-life into candidates for weekly or even monthly dosing regimens, potentially leading to novel drug products which and increased patient comfort."

Journal • Metabolic Disorders

A Study of Cotadutide in Participants Who Have Chronic Kidney Disease With Type 2 Diabetes Mellitus (clinicaltrials.gov) - P2 | N=248 | Completed | Sponsor: AstraZeneca | Phase classification: P2b ➔ P2

Phase classification • Chronic Kidney Disease • Diabetes • Metabolic Disorders • Nephrology • Renal Disease • Type 2 Diabetes Mellitus

Glucagon-like Peptide-1 Receptor Agonists for Adult Obesity: Where Next? (ISPOR-EU 2024) - "The most commonly assessed GLP-1 RAs were liraglutide and semaglutide (48%), followed by exenatide (24%) and dulaglutide (21%). Other less commonly identified agents included danuglipron, cotadutide, taspoglutide and mazdutide (2% each)... This research highlights growing interest and evidence in GLP-1 RAs for obesity management. Further research is needed to continue evaluating the long-term efficacy and safety of these interventions."

Clinical • Cardiovascular • Diabetes • Genetic Disorders • Hepatology • Metabolic Disorders • Metabolic Dysfunction-Associated Steatotic Liver Disease • Obesity • Polycystic Ovary Syndrome • Type 2 Diabetes Mellitus

Safety and Pharmacokinetics of AZD9550, a GLP-1R/GCGR Dual Agonist, in a First-in-Human Study (OBESITY WEEK 2024) - "Background: Cotadutide was a synthetic once-daily GLP-1R/GCGR dual peptide agonist with a relative potency ratio of approximately 5:1... AZD9550 led to dose-dependent reductions in body weight in obese mice. In healthy participants, there were no safety or tolerability concerns with a pharmacokinetic profile supporting once-weekly dosing. AZD9550 is a novel, investigational drug for obesity with an optimized ratio of glucagon and GLP-1R agonism that is being studied further as a treatment to maximize weight loss and end-organ protection."

Clinical • P1 data • PK/PD data • Genetic Disorders • Obesity • Pain

Glucagon and glucagon-like peptide-1 dual agonist therapy: A possible future towards fatty kidney disease. (PubMed, Eur J Clin Invest) - "Glucagon-like peptide-1 agonists and sodium-glucose cotransporter-2 inhibitors are two novel classes of glucose-lowering medications with potential implications and beneficiary effects on renal outcomes, including estimated glomerular filtration rate, albuminuria and chronic kidney disease progression. Recently, dual agonist therapies targeting glucagon-like peptide-1 and glucagon receptors, namely survodutide and cotadutide, have been evaluated in managing metabolically associated fatty liver disease, a well-established example of visceral obesity. Fatty kidney is another novel concept implicated in the pathophysiology of chronic kidney disease among patients with visceral obesity."

Journal • Review • Atherosclerosis • Cardiovascular • Chronic Kidney Disease • CNS Disorders • Diabetes • Dyslipidemia • Genetic Disorders • Hepatology • Metabolic Disorders • Nephrology • Obesity • Renal Disease • Vascular Neurology

A randomized phase 2b trial examined the effects of the glucagon-like peptide-1 and glucagon receptor agonist cotadutide on kidney outcomes in patients with diabetic kidney disease. (PubMed, Kidney Int) - "Safety and tolerability of cotadutide 600 μg were comparable to semaglutide. Thus, our study shows that in patients with T2Dand CKD, cotadutide significantly reduced UACR on top of standard of care with an acceptable tolerability profile, suggesting kidney protective benefits that need confirmation in a larger study."

Journal • P2b data • Chronic Kidney Disease • Diabetes • Diabetic Nephropathy • Metabolic Disorders • Nephrology • Renal Disease • Type 2 Diabetes Mellitus

Exposure-response modeling for nausea incidence for cotadutide using a Markov modeling approach. (PubMed, CPT Pharmacometrics Syst Pharmacol) - "The simulations indicated that the biweekly titration with twofold dose escalation is superior to other titration schemes with a relatively low predicted nausea event rate at 600 μg (25%) and a shorter titration interval (8 weeks) to reach the therapeutic dose. The model can be utilized to optimize starting dose and titration schemes for other therapeutics in clinical trials to achieve an optimal risk-benefit balance and reach the therapeutic dose with minimal titration steps."

Journal • Gastrointestinal Disorder • Genetic Disorders • Hepatology • Metabolic Dysfunction-Associated Steatohepatitis • Obesity