Heartbeats, Sleep, and Earnings
Week Of January 31 – February 6, 2026
This week’s newsletter highlights where GLP-1s are headed beyond weight loss and diabetes. Two independent academic groups (in Germany and Taiwan) simultaneously registered trials testing whether incretins can improve atrial fibrillation outcomes after catheter ablation. Meanwhile, the obstructive sleep apnea space continues to heat up with ecnoglutide entering Phase 3. On the business side, Lilly, Pfizer, and Amgen all reported earnings with significant GLP-1/obesity updates, and Novo Nordisk fired a shot across the bow at Hims & Hers over compounded semaglutide.
🔥 THIS WEEK’S KEY DEVELOPMENTS
CagriSema shows superior blood sugar, weight loss in Phase 3 trial.
In the Phase 3 REIMAGINE 2 trial, Novo Nordisk’s once-weekly CagriSema demonstrated superior HbA1c reduction and weight loss versus semaglutide in adults with type 2 diabetes. At 68 weeks, CagriSema 2.4 mg/2.4 mg achieved a 1.91%-point HbA1c reduction and 14.2% weight loss, compared to a 1.76%-point HbA1c reduction and 10.2% weight loss for semaglutide 2.4 mg. The company reported that CagriSema appeared to have a safe and well-tolerated profile consistent with incretin and amylin-based therapies.
Press | Trial: NCT06065540 (REIMAGINE 2) | Mechanism: GLP-1 receptor agonist + amylin receptor agonist
Novo Nordisk threatens legal action over Hims & Hers’ compounded semaglutide.
On February 5, 2026, Novo Nordisk issued a statement regarding Hims & Hers’ announcement to market a compounded semaglutide pill. Novo Nordisk described the Hims & Hers product as an “unlawfully mass-marketed, unapproved, inauthentic, and untested knockoff.” The company stated it is the sole manufacturer of the FDA-approved Wegovy® pill, which is available in all doses and in full supply nationwide in the US.
Press | Mechanism: GLP-1
Lilly reports strong Q4 driven by Mounjaro and Zepbound.
Eli Lilly reported Q4 2025 revenue increased 43% to $19.3 billion, driven by Mounjaro sales of $7.4 billion and Zepbound sales of $4.2 billion. The company announced positive Phase 3 results for retatrutide in obesity and knee osteoarthritis, which delivered weight loss of up to an average of 71.2 lbs. Lilly also submitted its oral GLP-1, orforglipron, for obesity approval to regulatory authorities in the U.S. and Japan.
Press | Mechanism: GLP-1 receptor agonists (injectable and oral)
📰 PRESS RELEASES
Pfizer’s danuglipron (PF-07976016), acquired via Metsera (formerly MET097), shows robust Phase 2b weight loss.
Amgen Q4 results highlight MariTide Phase 2 data: sustained weight loss and T2D benefits.
Press | Mechanism: GLP-1 receptor agonist + GIP receptor antagonist (antibody-peptide conjugate)
💡 TRIAL SPOTLIGHT
Educational spotlight selected by editors
Two New Trials, One Hypothesis: Can GLP-1 Drugs Improve Atrial Fibrillation Ablation Outcomes?
The recent, simultaneous registration of two independent academic trials, SPICE-AF in Germany and TREAT-AF in Taiwan, signals a strategic convergence in cardiology research, as both aim to determine if incretin-based drugs can improve outcomes for atrial fibrillation (AF) patients undergoing catheter ablation. The mechanistic rationale is compelling: by targeting obesity, a key driver of AF, GLP-1 agonists like semaglutide (SPICE-AF) and the dual GLP-1/GIP agonist tirzepatide (TREAT-AF) may reduce the pro-inflammatory epicardial fat that promotes the arrhythmia. These studies join a growing landscape of approximately 10 trials investigating the role of GLP-1s in AF, reflecting rising confidence in this therapeutic hypothesis. This parallel investigation by separate research groups underscores a pivotal moment for incretins, potentially expanding their use beyond metabolic disease to improving the success of cardiovascular procedures.
🔬 MECHANISM EXPLAINED
Understanding the science behind the therapeutics
From Diabetes Drug to Sleep Medicine: How GLP-1 Agonists Treat Obstructive Sleep Apnea (Example drugs: Tirzepatide, Ecnoglutide (XW003))
GLP-1 receptor agonists treat obstructive sleep apnea (OSA) primarily by inducing significant weight loss, which directly addresses the anatomical causes of the condition. Obesity, a major risk factor for OSA, leads to fat deposition in the tongue and pharyngeal walls, narrowing the upper airway and increasing its collapsibility during sleep. By promoting weight reduction of 15-25%, these drugs reduce the fat that physically constricts the airway and also lessen abdominal fat, which improves lung volumes and the “tracheal tug” that helps keep the airway open. Eli Lilly’s tirzepatide validated this approach in the SURMOUNT-OSA trial, demonstrating a nearly 50% reduction in apnea-hypopnea events and securing FDA approval, a landmark for a condition historically managed by devices. This success has transformed OSA into a major therapeutic battleground, attracting numerous competitors and fueling at least 12 active late-stage trials for similar metabolic drugs, including dual agonists, antibody-drug conjugates, and even amylin agonists. The rapid evolution from a novel concept to a crowded, approved indication underscores the massive unmet need for effective, non-device-based OSA treatments.
🆕 NEWLY REGISTERED TRIALS (6 in last week)
Eloralintide Phase 3 study investigating the drug as an add-on therapy for persistent obesity in patients already being treated with a weekly incretin (Eli Lilly and Company, n=900).
[Weight Loss/Efficacy]
Trials: NCT07392190 (ENLIGHTEN-6) | Mechanism: Amylin receptor agonist
Phase 1 pharmacokinetic study assessing the impact of renal insufficiency on an investigational drug’s exposure (Sun Pharmaceutical, n=40)
[Safety/Tolerability]
Trials: NCT07385547 | Mechanism: GLP-1 receptor agonist
SPICE-AF Phase IV investigating if semaglutide prior to catheter ablation improves outcomes in patients with atrial fibrillation (University of Luebeck, n=240)
[New Indications]
Trials: NCT07389941 (SPICE-AF) | Mechanism: GLP-1 receptor agonist
Oral semaglutide trial investigating its effect on chronic kidney disease in patients with metabolic dysfunction-associated fatty liver disease (MAFLD) (Institute of Liver and Biliary Sciences, India, n=90).
[Oral Formulations | New Indications]
Trials: NCT07391267 | Mechanism: GLP-1 receptor agonist
XW003 Phase 3 trial in obese participants with obstructive sleep apnea who are not receiving positive airway pressure therapy (Hangzhou Sciwind Biosciences, n=140)
[Weight Loss/Efficacy | New Indications]
Trials: NCT07387094 | Mechanism: GLP-1 receptor agonist
Tirzepatide to Reduce rEcurrence And Burden After Ablation of Atrial Fibrillation (TREAT-AF) trial investigating if tirzepatide can prevent AFib recurrence post-ablation (National Taiwan University Hospital, n=200)
[Weight Loss/Efficacy | New Indications]
Trials: NCT07382024 (TREAT-AF) | Mechanism: Dual GLP-1/GIP agonist
This newsletter compiles publicly available information from company press releases and ClinicalTrials.gov. Not investment advice.
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