EASD 2026: Amylin Combos Emerge as the Next Frontier; Lilly Leans on Indirect Head-to-Head Claims

EASD 2026: Amylin Combos Emerge as the Next Frontier; Lilly Leans on Indirect Head-to-Head Claims

At the European Association for the Study of Diabetes meeting in Milan (Sept 28–Oct 2, 2026), both incumbents pivoted the efficacy narrative toward amylin-based combination injectables — a mechanism with GLP-1-comparable weight loss but roughly half the GI side-effect burden, per investigators. Lilly reported that EloraTZP, its combination of the amylin analogue eloralintide with tirzepatide, "helped people who were overweight or had obesity and also had Type 2 diabetes to lose 23% of their starting body weight compared to 14.8% among those using tirzepatide alone after nearly a year", with superior A1C reduction versus either component alone; combination studies begin this year. Novo countered with CagriSema at 22.4% weight loss at one year vs. placebo, plus fMRI evidence it blunts "food noise," liver/pancreas fat reduction in T2D, and early data on diabetic neuropathic pain. Novo's obesity NDA is at FDA with a decision expected by end of 2026 (tracked by the standing CagriSema watch). Zealand/Roche's petrelintide added Phase 2 data published in the Lancet (Sept 29): 10% mean weight loss vs. 1.7% placebo with placebo-like tolerability¹, and the Phase 3 ZUPREME program began Sept 22. Dr. Timothy Garvey, who led the petrelintide trial: "The amylins still cause some nausea, but it's at less than half the rate of what we generally see in GLP-1 trials."

Lilly also escalated the commercial war with indirect cross-trial comparisons (BioSpace, Sept 30): pooling its Phase 3 ACHIEVE-3 with Novo's PIONEER PLUS, 17.2 mg Foundayo showed 1.5–2.4% greater weight loss and 0.3–0.6% greater HbA1c reduction vs. oral semaglutide; separately, SURMOUNT-1 vs. STEP UP data showed Zepbound 10/15 mg delivered up to 4.5% greater weight reduction than high-dose (7.2 mg) injectable Wegovy, with patients up to 3x more likely to lose ≥20% of body weight. BMO Capital called the readouts "indirect but encouraging" — "supportive and commercially useful rather than a form of definitive proof" — but noted they "could help build momentum around Foundayo following a slower-than-hoped launch start."

The challenger wave is broad and increasingly amylin-centric: Pfizer's monthly injectable berobenatide (Metsera) showed up to 12.3% placebo-adjusted weight loss at 28 weeks with ten Phase 3 trials planned in 2026; Amgen's MariTide MARITIME program includes MARITIME-SWITCH, enrolling patients moving off weekly tirzepatide/semaglutide onto every-8-week or quarterly dosing — "Amgen is, in no uncertain terms, coming after Novo and Eli Lilly's customers"; AbbVie's Gubra-licensed amylin ABBV-295 showed 7.75–9.79% weight loss at week 12 in Phase 1; Roche's enicepatide hit 22.5% placebo-adjusted at 48 weeks in Phase 2. China is now a molecule source: Novo licensed Hengrui's once-weekly oral GLP-1/GIP candidate HRS-1596 on Sept 29 ($300M upfront, up to $2.6B) — pre-Phase 1 — while Pfizer paid up to $495M for China rights to Sciwind's ecnoglutide and licensed an oral from YaoPharma.

Market context for the race: LLY trades at a $1.02T market cap on +47.7% revenue growth, while NVO sits at a 9.4 P/E, down 21.4% in a month (see Novo's Slide Deepens Post-CMD: Stock -21.4% in a Month, RSI 21, Trading at 9.4x Earnings). Script-level detail in Oral GLP-1 Battle Flips: Foundayo Surges 21% to 64K Weekly Scripts While Wegovy Pill Stalls at ~182K.