Eloralintide: Eli Lilly's amylin drug, and how it compares with cagrilintide

Amylin acts through three receptors built on the calcitonin receptor, and drug designers can tune which ones a molecule prefers. In cell studies, eloralintide preferentially activated human AMY1R: 12-fold more than the calcitonin receptor and 11-fold more than AMY3R ^[1]. Its pharmacokinetics in rats, monkeys and people supported once-weekly dosing ^[1].

Lilly's reason for selectivity was tolerability. In lean rats, eloralintide caused significantly less conditioned taste avoidance, a laboratory marker of nausea-like aversion, than cagrilintide, which the same paper describes as a non-selective amylin receptor agonist ^[1]. In diet-induced obese rats it reduced food intake and body weight, mainly through loss of fat mass ^[1]. Whether the rat advantage on aversion carries over to people is the question the human trials are answering.

For "amylin Eli Lilly" searches: eloralintide is Lilly's lead amylin drug and the one it has taken into phase 3 ^[3]; Lilly is also testing it in combination with its approved GLP-1 and GIP drug tirzepatide ^[3].

Two phase 1 studies tested eloralintide in people. In a single-dose study in 48 healthy participants, nine people in the eloralintide groups reported 16 adverse events, 15 of them mild, and four gastrointestinal events occurred in two participants ^[1]. A single dose of 4 mg or 12 mg reduced body weight by 2.5% and 4.4% at week 4, against a 0.6% gain on placebo ^[1].

A 12-week multiple-dose study in 100 participants with obesity or overweight gave weekly doses with no escalation. Weight fell by 2.6% to 11.3% across dose groups at week 12 ^[4]. The most common adverse events were decreased appetite (19%), headache (12%), fatigue (11%) and COVID-19 (11%); diarrhoea (10%), nausea (8%) and vomiting (4%) were described as infrequent ^[4]. One serious adverse event occurred, judged unrelated to eloralintide ^[4].

The phase 2 trial, published in The Lancet in November 2025, enrolled 263 adults without type 2 diabetes at 46 US centres, with a mean starting weight of 109.1 kg; 78% were women ^[2]. Participants were randomised to weekly placebo, fixed doses of 1, 3, 6 or 9 mg, or two escalation schemes, for 48 weeks ^[2].

Sources for the table: Lancet figures and nausea rates ^[2]; one-decimal figures from Lilly's announcement, which noted the endpoints were not adjusted for multiplicity ^[5]. Fatigue was the other common adverse event, ranging from 0% at 1 mg to 46% in the 6 to 9 mg escalation arm, against 12% on placebo ^[2]. Lilly reported that gastrointestinal events were less frequent with slower escalation and similar to placebo at 1 mg and 3 mg ^[5]. The pattern in the table, where the 3 to 9 mg escalation arm had less nausea than starting at 6 mg, fits that account.

On 30 September 2026 Lilly reported a 48-week phase 2b trial in 367 adults with obesity or overweight and type 2 diabetes, combining eloralintide with tirzepatide ^[3].

All figures from Lilly's announcement ^[3]. The combination cost tolerability: discontinuation for adverse events ranged from 10.8% to 27.0% across EloraTZP arms, against 0% to 10.8% with eloralintide alone, 2.9% with tirzepatide and 16.7% with placebo ^[3]. These are company-reported, not yet peer-reviewed. Separately, cagrilintide has not been tested with tirzepatide in people; that gap is covered in cagrilintide with tirzepatide.

• Eloralintide alone: in phase 3 trials for obesity, in people with and without type 2 diabetes ^[3]. Lilly said in November 2025 that it planned to start these by the end of that year ^[5].
• EloraTZP: Lilly plans to start phase 3 of a co-formulated product by the end of 2026 ^[3].
• Approval: none. Lilly describes eloralintide as investigational, with no guarantee of approval ^[3]. No regulatory filing has been announced.

By comparison, Novo Nordisk filed CagriSema with the FDA in December 2025 ^[6] and has cagrilintide alone in its RENEW phase 3 programme ^[7]. Cagrilintide is about one development stage ahead. The wider set of drugs in this race is in new weight-loss drugs.

Read the weight-loss row carefully. The eloralintide figure is from 48 weeks; the cagrilintide phase 2 figure is from 26 weeks, a trial too short to reach a plateau. Cagrilintide's 68-week monotherapy figure of 11.8% ^[7] is the fairer comparison, and eloralintide still looks larger. A 2026 network meta-analysis estimated high-dose eloralintide at -18.01% against placebo and high-dose CagriSema at -17.18%, while warning the data were sparse and low in certainty ^[10].

On tolerability the case is not settled. Eloralintide's selectivity reduced aversion in rats ^[1], but its phase 2 nausea rate reached 64% in the 6 mg arm ^[2], higher than cagrilintide's top phase 2 rate of 47% ^[8]. Escalation schedules, trial populations and durations differ, so neither number settles which drug is gentler. Cagrilintide's mechanism is in how cagrilintide works, and its full record is the cagrilintide compound page.