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Investigative ecnoglutide shows promise for weight management

Researchers report that investigative ecnoglutide is a safe and effective treatment for weight management in individuals who are overweight or obese and who do not have diabetes.
The findings from a phase 3 randomized controlled trial appeared on June 21, 2025 in The Lancet Diabetes & Endocrinology.
“In adults with obesity or overweight without diabetes (type 1 or 2), individuals administered ecnoglutide had superior and sustained reduction in bodyweight versus placebo with a favourable safety profile, supporting its potential use for weight management,” the authors said.
The randomized SLIMMER trial was conducted at 36 medical centers in China.
The trial showed that subjects taking ecnoglutide lost an average of between 9% and 13% of their body weight after 40 weeks of treatment, compared to virtually no weight loss in the placebo cohort, suggesting that ecnoglutide is as safe and effective as other approved GLP-1 receptor agonists such as semaglutide or tirzepatide.
Eligible subjects were aged 18–75 years, and they had been diagnosed as overweight or obese (defined as BMI ≥28 kg/m² or ≥24 kg/m² with at least one weight-related comorbidity [prediabetes, hypertension, hyperlipidaemia, metabolic dysfunction-associated steatotic liver disease, obstructive sleep apnoea syndrome, or weight-bearing joint pain]), but without diabetes (type 1 or 2).
Subjects were randomized to receive subcutaneous ecnoglutide or volume-matched placebo, once weekly. They were stratified by BMI at screening (≥28 kg/m² and <28 kg/m²).
The coprimary endpoints were percentage change in bodyweight and proportion of subjects with a reduction in bodyweight of 5% or more at week 40.
The investigators assigned 664 subjects to receive either ecnoglutide 1.2 mg (n=166), ecnoglutide 1.8 mg (n=166), ecnoglutide 2.4 mg (n=167), or placebo (n=165).
At week 40, the mean percentage change in bodyweight was –9.1% in the ecnoglutide 1.2 mg group, –10.9% in the ecnoglutide 1.8 mg group and –13.2% in the ecnoglutide 2.4 mg group versus 0.1% in the placebo group, a statistically significant difference from placebo for all ecnoglutide cohorts.
The proportion of subjects who achieved at least a 5% reduction in bodyweight at week 40 was 77% in the ecnoglutide 1.2 mg group, 84% in the ecnoglutide 1.8 mg group and 87% in the ecnoglutide 2.4 mg group versus 16% of subjects in the placebo group. The difference from placebo for all ecnoglutide groups was statistically significant.
The researchers reported treatment-related adverse events in 155 (93%) of 166 subjects in the ecnoglutide 1.2 mg group, 154 (93%) of 166 subjects in the ecnoglutide 1.8 mg group, 156 (93%) of 167 subjects in the ecnoglutide 2.4 mg group, and 139 (84%) of 165 subjects in the placebo group.
They said, “The most common adverse events were mild-to-moderate gastrointestinal related events. Ten participants treated with ecnoglutide discontinued treatment due to adverse events.”
The authors noted that that subjects on the higher doses of ecnoglutide continued to achieve weight loss up to week 48, suggesting that greater weight loss might be achieved with longer ecnoglutide treatment.