CagriSema vs Zepbound: The Pipeline Challenger, Measured
CagriSema (cagrilintide + semaglutide, Novo Nordisk) vs Zepbound (tirzepatide, Eli Lilly)
Last verified July 2026
The verdict
About 20.4% at 68 weeks for CagriSema in REDEFINE-1 (PMID 40544433) against up to about 20.9% at 72 weeks for Zepbound's 15 mg arm in SURMOUNT-1 (PMID 35658024). Effectively level on the headline figures, across different trials and durations. CagriSema is trials-only; Zepbound is prescribable at about $550 a month with the Lilly savings card. Until a head-to-head exists, calling either one better is a forecast rather than a finding.
Side-by-side comparison
| Field | CagriSema | Zepbound |
|---|---|---|
| Peak weight loss (vs placebo) | ~20.4% at 68 wk — REDEFINE-1 (PMID 40544433) | Up to ~20.9% (15 mg arm) at 72 wk — SURMOUNT-1 (PMID 35658024) |
| Head-to-head data | No direct RCT vs tirzepatide reported as of mid-2026 | No direct RCT vs CagriSema reported as of mid-2026 |
| Mechanism of action | Amylin receptor + GLP-1 receptor agonist (cagrilintide + semaglutide 2.4 mg) | Dual GIP receptor + GLP-1 receptor agonist (tirzepatide) |
| FDA approval status | Investigational — not FDA-approved (as of mid-2026) | FDA-approved for chronic weight management since November 2023 |
| Cardiovascular outcomes | No completed CV outcomes trial; data pending | SURMOUNT-MMO trial ongoing; CV indication not yet approved |
| Administration | Once-weekly subcutaneous injection (investigational dosing) | Once-weekly subcutaneous injection (2.5–15 mg, dose escalation) |
| Commercial availability & price | Not commercially available — clinical trials only | Available by prescription; ~$550/mo with Lilly savings card |
What each one costs in the compounded market
Standing monthly cash prices from the 556 sellers on this register. These are compounded preparations, not the approved products compared above.
CagriSema — cagrilintide + semaglutide
No seller on this register publishes a compounded price for it. For a drug still in trials that is expected — and anyone selling it anyway is doing so outside the system this register covers.
Zepbound — tirzepatide
from $99 /mo
253 sellers publish a standing price; the median is $240 a month.
⚠ A compounded preparation is not the approved product. No agency has reviewed that specific preparation for safety, effectiveness or manufacturing quality, and the legal ground under compounding these molecules narrowed when the shortages closed. The price gap is real, and so is the difference in oversight. Every seller, with its price record.
Frequently asked questions
Which works better for weight loss, CagriSema or Zepbound?
On the trial evidence, neither clearly. CagriSema recorded ~20.4% at 68 wk — REDEFINE-1 (PMID 40544433) and Zepbound Up to ~20.9% (15 mg arm) at 72 wk — SURMOUNT-1 (PMID 35658024), and the head-to-head comparison put CagriSema at No direct RCT vs tirzepatide reported as of mid-2026 against Zepbound at No direct RCT vs CagriSema reported as of mid-2026. A head-to-head is the strongest form of this evidence because both arms run under one protocol — separate trials are not directly comparable however alike they look.
Are CagriSema and Zepbound the same drug?
No. CagriSema is cagrilintide + semaglutide and Zepbound is tirzepatide — different molecules, and they work differently: Amylin receptor + GLP-1 receptor agonist (cagrilintide + semaglutide 2.4 mg) against Dual GIP receptor + GLP-1 receptor agonist (tirzepatide). Results with one do not predict results with the other.
Is CagriSema or Zepbound cheaper?
On the manufacturers' own cash pricing: CagriSema at Not commercially available — clinical trials only, Zepbound at Available by prescription; ~$550/mo with Lilly savings card. ⚠ That is the list-price comparison, and it is not what most people pay. What you actually pay depends on whether your plan covers it, which formulary tier it sits in, and whether you have met your deductible — and for many people the honest comparison is between an insured copay and a cash-pay compounded alternative rather than between these two figures.
Does either one have better cardiovascular evidence?
Neither has a clear edge does. CagriSema: No completed CV outcomes trial; data pending. Zepbound: SURMOUNT-MMO trial ongoing; CV indication not yet approved. This matters more than it first appears — a drug with a completed outcomes trial has evidence about events that matter, not only about weight, and that is often what decides coverage.
How is each one taken?
CagriSema: Once-weekly subcutaneous injection (investigational dosing). Zepbound: Once-weekly subcutaneous injection (2.5–15 mg, dose escalation). Worth weighing honestly against your own habits — the best drug for you is partly the one you will still be taking in eight months, and a dosing routine that does not fit a life gets abandoned.
What does a compounded version of each actually cost?
Across the 556 sellers in this register, the cheapest standing monthly cash prices we hold are tirzepatide from $99 a month. ⛔ A compounded preparation is not the approved product: no agency has reviewed that specific preparation for safety, effectiveness or manufacturing quality, and the legal ground under compounding these molecules narrowed once the shortages closed. The price gap is real and so is the difference in oversight.
Can I switch from CagriSema to Zepbound?
Yes, with a prescriber. Expect to re-titrate from the bottom of the new drug's ladder rather than starting where you left off: these are different molecules and tolerance to one does not transfer to the other. Both the old drug's washout and the new drug's schedule apply.
Which one should I ask for?
That is a prescriber's call, and anyone answering it from a table is guessing. What a page like this can do is tell you what the trials measured, what the manufacturers charge, and where the evidence is still missing, so the conversation starts from the record rather than from an advertisement.
References
- 1.Garvey WT, Blüher M, et al. Coadministered Cagrilintide and Semaglutide in Adults with Overweight or Obesity (REDEFINE 1) N Engl J Med. 2025;393(7):635-647. 2025. PMID: 40544433.
- 2.Jastreboff AM, Aronne LJ, Ahmad NN, et al. Tirzepatide Once Weekly for the Treatment of Obesity (SURMOUNT-1) N Engl J Med. 2022;387(3):205-216. 2022. PMID: 35658024.
- 3.Davies MJ, Bajaj HS, et al. Cagrilintide-Semaglutide in Adults with Overweight or Obesity and Type 2 Diabetes (REDEFINE 2) N Engl J Med. 2025;393(7):648-659. 2025. PMID: 40544432.
- 4.Yamauchi T, Becker NP, Hagemann CA, et al. Efficacy and safety of co-administered cagrilintide and semaglutide versus semaglutide alone in adults with overweight or obesity Lancet Diabetes Endocrinol. 2026;14(6):450-462. 2026. PMID: 42009015.
- 5.Wilding JPH, Batterham RL, Calanna S, et al. Once-Weekly Semaglutide in Adults with Overweight or Obesity (STEP 1) N Engl J Med. 2021;384(11):989-1002. 2021. PMID: 33567185.
Related comparisons
- Wegovy vs Zepbound
- Ozempic vs Mounjaro
- Semaglutide vs Tirzepatide
- Rybelsus vs Ozempic
- Mounjaro vs Zepbound
- Foundayo vs Rybelsus
See the full drug-vs-drug verdict index or provider rankings.