Ecnoglutide (code name XW003) is a once-weekly injectable glucagon-like peptide-1 (GLP-1) receptor agonist, the same drug class as semaglutide and dulaglutide. It was discovered and developed by Sciwind Biosciences in Hangzhou, China. Its developers describe it as “cAMP-biased”: in lab tests it strongly switches on the receptor’s main signaling pathway while triggering little receptor internalization (the cell pulling the receptor inside and switching it off).
The single most important fact: ecnoglutide is approved only in China. China’s drug regulator, the National Medical Products Administration (NMPA), approved it in January 2026 for blood-sugar control in adults with type 2 diabetes, and in March 2026 for long-term weight management in adults with obesity, or overweight with at least one weight-related condition (Shirley, Drugs 2026). As of Sciwind’s most recent update (dated September 30, 2026, posted October 8, 2026), these two Chinese approvals remain its only approvals (Sciwind, EASD 2026 release). It is not approved by the FDA or EMA, and almost all efficacy data come from Chinese adults.
This page summarizes what the published clinical trials, trial registries and company disclosures report. It is for education only and is not medical advice.
| Property | Detail |
|---|---|
| Drug class | GLP-1 receptor agonist (single agonist, described as cAMP-biased) |
| Developer / code | Sciwind Biosciences (XW003); Pfizer holds exclusive commercialization rights in mainland China |
| Approval | China (NMPA): type 2 diabetes January 2026; chronic weight management March 2026. Not FDA- or EMA-approved |
| Route | Subcutaneous injection once weekly; an oral tablet is in early trials |
| Doses studied | Type 2 diabetes: 0.4–1.2 mg/week; obesity: 1.2, 1.8 and 2.4 mg/week |
| Half-life | 124–138 h (about 5–6 days) at steady state in healthy adults (phase 1) |
| Key structural feature | Valine at position 8 and a C18 fatty-acid chain on position 30; only natural amino acids |
| US controlled-substance status | Not listed in DEA Schedule III (21 CFR 1308.13) |
| WADA status | Not named on the 2026 List |
What it is
Native GLP-1 is a gut hormone released after meals. It stimulates insulin release when glucose is high, lowers glucagon, slows stomach emptying and reduces appetite. On its own it lasts only about 2 minutes in the blood because the enzyme DPP-4 breaks it down (Guo et al., Mol Metab 2023).
Ecnoglutide is a modified version of human GLP-1. The discovery paper describes two main changes (Guo et al., Mol Metab 2023):
| Change | What it does |
|---|---|
| Alanine at position 8 replaced by valine | Protects against DPP-4 breakdown and has been reported to favor cAMP-biased signaling. Semaglutide instead uses an unnatural amino acid (Aib) at this spot. |
| C18 diacid fatty-acid chain attached to a lysine at position 30 (via a linker) | Lets the drug bind albumin in the blood, which extends its half-life. Semaglutide and liraglutide carry their fatty chain at position 26. |
Because ecnoglutide contains only natural amino acids, the full peptide can be made from recombinant DNA before the fatty chain is added. The developers state this takes fewer manufacturing steps than semaglutide.
What “cAMP-biased” means
When a GLP-1 drug binds its receptor, the receptor sends signals through cyclic AMP (cAMP), a messenger that drives insulin release, and also recruits proteins called β-arrestins, which help pull the receptor into the cell. In cell-culture tests, ecnoglutide induced cAMP at very low concentrations (EC50, the concentration giving half the maximal effect, of 0.018 nM) but did not cause measurable receptor internalization even above 10 μM (Guo et al., Mol Metab 2023). In mice and rats, it lowered glucose and body weight more than semaglutide.
These are lab and animal findings. Whether biased signaling gives a meaningful clinical advantage in people is still being tested; the only head-to-head comparison so far is an interim company readout (see below). Tirzepatide has also been described as cAMP-biased at the GLP-1 receptor (Guo et al., Mol Metab 2023).
Pharmacokinetics
The first-in-human trial (NCT04389775), run in Australia in 64 healthy volunteers, tested single doses of 0.03–1.0 mg and weekly doses up to 0.6 mg for 6 weeks (Guo et al., Mol Metab 2023). Steady-state results:
| Parameter (steady state, day 36) | 0.2 mg | 0.4 mg | 0.6 mg |
|---|---|---|---|
| Mean half-life | 124 h | 138 h | 129 h |
| Median time to peak | 72 h | 39 h | 12 h |
| Mean peak level | 25.3 ng/mL | 46.7 ng/mL | 84.7 ng/mL |
| Accumulation ratio (AUC) | 1.81 | 1.97 | 2.23 |
Exposure rose in proportion to dose, and the half-life of about 5–6 days supports once-weekly dosing. The authors noted semaglutide’s half-life is about 165 h by comparison. In adolescents aged 12–17, Sciwind reports drug exposure broadly similar to adults (Sciwind, EASD 2026 release).
Approved medical use
As of the newest sources available (October 2026), ecnoglutide injection is approved only in China:
| Date | Regulator | Indication | Pivotal evidence |
|---|---|---|---|
| January 2026 | NMPA (China) | Glycemic control in adults with type 2 diabetes | EECOH-1 and EECOH-2 phase 3 trials |
| March 2026 | NMPA (China) | Long-term weight management, with diet and physical activity, in adults with obesity, or overweight with at least one weight-related comorbidity | SLIMMER phase 3 trial |
Sources: Shirley, Drugs 2026; Sciwind, January 30, 2026; Sciwind, March 6, 2026.
Sciwind remains the marketing authorization holder and manufacturer. In February 2026 it gave Pfizer exclusive commercialization rights in mainland China, with up to $495 million in upfront and milestone payments (Sciwind, February 24, 2026). We could not access the Chinese prescribing information, so labeled starting and maintenance doses are not given here; the doses below are those used in trials.
Outside China, ecnoglutide has no approval. An oral tablet (also coded VRB-101) is being tested by Verdiva Bio in US phase 2 trials: a weight-loss trial completed in July 2026 with no results posted, and a weight-maintenance trial is ongoing (NCT07281937; NCT07553299).
What the research shows
Weight management (SLIMMER, phase 3)
This randomized, double-blind, placebo-controlled trial enrolled 664 Chinese adults without diabetes who had a BMI of 28 kg/m² or more, or 24 kg/m² or more with a weight-related condition (Ji et al., Lancet Diabetes Endocrinol 2025). Participants received weekly ecnoglutide 1.2, 1.8 or 2.4 mg, or placebo. The co-primary endpoints were measured at week 40:
| Outcome at week 40 | Placebo | 1.2 mg | 1.8 mg | 2.4 mg |
|---|---|---|---|---|
| n randomized | 165 | 166 | 166 | 167 |
| Mean body-weight change | +0.1% | −9.1% | −10.9% | −13.2% |
| Difference vs placebo (97% CI) | — | −9.2% (−11.0 to −7.5) | −11.1% (−13.1 to −9.1) | −13.3% (−15.3 to −11.3) |
| Lost 5% or more of body weight | 16% | 77% | 84% | 87% |
| Any adverse event | 84% | 93% | 93% | 93% |
All differences versus placebo were significant (p under 0.0001). Ten participants on ecnoglutide stopped treatment because of adverse events.
Sciwind reports that at week 48 the 2.4 mg group had lost 15.4% of body weight (15.1% more than placebo), with 92.8%, 79.6% and 63.5% reaching at least 5%, 10% and 15% weight loss. The company also reports a 53.1% average fall in liver fat at week 40 in people with liver fat of 8% or more at baseline (Sciwind, March 6, 2026). These figures come from the company’s summary rather than the trial abstract.
The sources we could access do not report body-composition (lean versus fat mass) results for ecnoglutide, so its effect on muscle mass is unknown.
Type 2 diabetes
Three placebo- or active-controlled trials in Chinese adults support the diabetes approval:
| Trial | Design, n | Comparator | Duration | HbA1c change |
|---|---|---|---|---|
| Phase 2 (Zhu et al., Nat Commun 2024) | Double-blind, 145 adults on diet/exercise or one oral drug | Placebo | 20 weeks | 0.4 mg −1.81%; 0.8 mg −1.90%; 1.2 mg −2.39%; placebo −0.55% |
| EECOH-1, phase 3 (Zhu et al., Nat Commun 2026) | Double-blind, 211 adults on diet/exercise or one oral drug | Placebo | 24 weeks (+28 open-label) | 0.6 mg −1.96%; 1.2 mg −2.43%; placebo −0.87% |
| EECOH-2, phase 3 (He et al., Lancet Diabetes Endocrinol 2025) | Open-label, 621 adults on metformin | Dulaglutide 1.5 mg | 32 weeks (to 52) | 0.6 mg −1.91%; 1.2 mg −1.89%; dulaglutide −1.65% |
HbA1c reflects average blood glucose over about 3 months. Key details:
- EECOH-1. The differences versus placebo were −1.09% (95% CI −1.40 to −0.77) for 0.6 mg and −1.56% (95% CI −1.87 to −1.24) for 1.2 mg. At week 24, 80.3% on 1.2 mg reached an HbA1c under 7.0%, versus 21.1% on placebo. Improvements were maintained to week 52.
- EECOH-2. Both doses were non-inferior to dulaglutide, and 1.2 mg was statistically superior (difference −0.24%, 95% CI −0.38 to −0.11). The authors judged this difference not clinically relevant. Baseline HbA1c averaged 8.40%.
- Phase 2. At the end of treatment, 33.3% on 1.2 mg had lost at least 5% of body weight, versus 3.0% on placebo.
Head-to-head with semaglutide (interim, company-reported)
SLIMMER-UP-SWITCH is an open-label phase 2 trial in 163 Chinese adults with a BMI of 30 kg/m² or more, randomized to ecnoglutide or semaglutide, both at 2.4 mg weekly, for 60 weeks (NCT07073417). At a prespecified week-20 interim analysis presented at ADA 2026, Sciwind reported (Sciwind, June 8, 2026):
| Week 20 outcome | Ecnoglutide 2.4 mg | Semaglutide 2.4 mg |
|---|---|---|
| Mean body-weight change | −12.8% | −9.5% |
| Lost 10% or more | 74% | 40% |
| Waist reduction | 10.5 cm | 8.7 cm |
This is an interim, open-label result available only as a conference poster and press release. Twenty weeks is early in a 60-week trial, and the full results have not been published in a peer-reviewed journal.
Other populations and formulations
- Adolescents. In a phase 1b trial of 48 Chinese adolescents aged 12–17 with obesity (NCT07143227), Sciwind reports body-weight changes of −10.4% to −12.1% across the three doses at week 20, versus +1.2% on placebo, with no treatment-related serious adverse events (Sciwind, EASD 2026 release). A phase 3 adolescent trial is listed as not yet recruiting (NCT07836270).
- Obstructive sleep apnea and knee osteoarthritis. Phase 3 trials in adults with obesity are recruiting in China (NCT07387094; NCT07434050; NCT07734311).
- Oral tablet. Phase 1b/2a in China (NCT07243171) and the US phase 2 trials above. No efficacy results have been published.
Side effects and risks
No full prescribing information was available to us, so this section relies on published trials. The longest published trials lasted 52 weeks, and no cardiovascular outcomes trial has been reported.
Gastrointestinal effects
As with other GLP-1 drugs, gastrointestinal symptoms are the most common adverse events. They are mostly mild to moderate and most frequent during dose escalation. In EECOH-1 (Zhu et al., Nat Commun 2026):
| Adverse event (24 weeks) | Placebo | 0.6 mg | 1.2 mg |
|---|---|---|---|
| Decreased appetite | 4.2% | 21.7% | 26.8% |
| Diarrhea | 5.6% | 24.6% | 11.3% |
| Nausea | 9.9% | 7.2% | 12.7% |
| Abdominal distension | 1.4% | 4.3% | 8.5% |
| Asthenia (weakness) | 2.8% | 1.4% | 14.1% |
In the phase 2 diabetes trial, diarrhea occurred in 14.7% and nausea in 11.9% of ecnoglutide-treated participants, versus 2.8% each on placebo (Zhu et al., Nat Commun 2024). In the obesity phase 3 trial, 93% of each ecnoglutide group and 84% on placebo reported any adverse event (Ji et al., Lancet Diabetes Endocrinol 2025). In the first-in-human study, one volunteer given a single 1.0 mg dose had severe loss of appetite, and higher single doses were not tested (Guo et al., Mol Metab 2023).
Pancreatic enzymes, heart rate and hypoglycemia
In EECOH-1 (Zhu et al., Nat Commun 2026):
- Lipase rises (a pancreatic enzyme) were reported in 11.6% on 0.6 mg and 12.7% on 1.2 mg, versus 2.8% on placebo. They were not linked to symptoms, and no pancreatitis or gallbladder disorders were reported.
- Heart rate rose by a mean of 3.0 and 5.4 beats per minute on 0.6 and 1.2 mg, versus a fall of 1.6 on placebo.
- Hypoglycemia (blood glucose under 3.9 mmol/L, about 70 mg/dL) on lab testing occurred in 2.9–5.6% on ecnoglutide versus 1.4% on placebo, with no severe episodes.
Who has been excluded from trials
The phase 2 diabetes trial excluded people with a history of pancreatitis or a personal or family history of medullary thyroid cancer or multiple endocrine neoplasia type 2 (Zhu et al., Nat Commun 2024). Approved GLP-1 drugs carry warnings about these conditions (see semaglutide). Ecnoglutide has not been studied in pregnancy, type 1 diabetes, athletes or trained lifters.
Interactions
GLP-1 drugs slow stomach emptying (Guo et al., Mol Metab 2023), which can change how fast oral medicines are absorbed. Two phase 1 studies in 28 healthy adults each tested common co-medications at steady-state ecnoglutide 1.2 mg:
| Drug | Effect on total exposure (AUC) with ecnoglutide | Conclusion |
|---|---|---|
| Rosuvastatin | 106% of baseline (90% CI 94–120%) | No clinically relevant change |
| Digoxin | 84% of baseline (90% CI 76–94%) | No dose change needed; monitoring advised, especially with kidney impairment |
| Metformin | Within the 80–125% no-effect range | No dose change needed |
| Warfarin | Within the no-effect range; INR unchanged | No dose change needed |
Sources: Li et al., Diabetes Obes Metab 2026; Chen et al., Front Pharmacol 2026. Peak levels of the co-administered drugs were modestly lower and delayed. In the rosuvastatin/digoxin study, healthy volunteers lost an average of 11.2% of body weight over the 14-week dosing period.
Legal status and use in sport
- United States. Ecnoglutide is not FDA-approved and cannot be legally prescribed. It is a peptide, not a steroid, and is not among the substances listed in Schedule III (21 CFR 1308.13).
- WADA. Ecnoglutide is not named on the 2026 Prohibited List, and GLP-1 receptor agonists are not listed as a class. The S0 class covers substances with “no current approval by any governmental regulatory health authority” (WADA 2026 Prohibited List). Because ecnoglutide is approved in China, it does not appear to fall under that catch-all. The List is revised every year.
Key takeaways
- A once-weekly GLP-1 drug approved only in China. NMPA approved it for type 2 diabetes in January 2026 and for weight management in March 2026; there is no FDA or EMA approval as of October 2026.
- Designed for biased signaling. It strongly activates cAMP signaling with little receptor internalization in lab tests; whether this adds clinical benefit is not yet settled.
- Substantial weight loss in Chinese trials. At 2.4 mg, weight fell 13.2% at 40 weeks versus a 0.1% gain on placebo in a 664-person phase 3 trial.
- Robust HbA1c lowering. Reductions of about 1.9–2.4% in phase 3, non-inferior to dulaglutide.
- Typical GLP-1 side effects. Decreased appetite, diarrhea and nausea were most common; lipase rises and a small heart-rate increase were also seen.
- Evidence gaps. No published head-to-head data beyond a 20-week interim readout, no outcomes trial, no body-composition data we could verify, and almost no data outside Chinese populations.
Sources
- Shirley M. Ecnoglutide: First Approvals. Drugs. 2026;86(9):1563–1570. PubMed.
- Guo W, Xu Z, Zou H, et al. Discovery of ecnoglutide - A novel, long-acting, cAMP-biased glucagon-like peptide-1 (GLP-1) analog. Mol Metab. 2023;75:101762. PubMed.
- Zhu D, Wang W, Tong G, et al. Efficacy and safety of GLP-1 analog ecnoglutide in adults with type 2 diabetes: a randomized, double-blind, placebo-controlled phase 2 trial. Nat Commun. 2024;15(1):8408. PubMed.
- Zhu D, Wang W, Tong G, et al. Efficacy and safety of cAMP signalling-biased GLP-1 analogue ecnoglutide monotherapy versus placebo in patients with type 2 diabetes (EECOH-1): a multi-centre, randomised, double-blind, placebo-controlled, phase 3 trial. Nat Commun. 2026;17(1):1420. PubMed.
- He Y, Mi N, Cheng Z, et al. Efficacy and safety of cAMP-biased GLP-1 receptor agonist ecnoglutide versus dulaglutide in patients with type 2 diabetes and elevated glucose concentrations on metformin monotherapy (EECOH-2): a 52-week, multicentre, open-label, non-inferiority, randomised, phase 3 trial. Lancet Diabetes Endocrinol. 2025;13(10):863–873. PubMed.
- Ji L, Gao L, Xue H, et al. Efficacy and safety of a biased GLP-1 receptor agonist ecnoglutide in adults with overweight or obesity: a multicentre, randomised, double-blind, placebo-controlled, phase 3 trial. Lancet Diabetes Endocrinol. 2025;13(9):777–789. PubMed.
- Li F, Du C, Yu Q, et al. Effect of a Novel GLP-1 Analogue Ecnoglutide on the Pharmacokinetics of Rosuvastatin and Digoxin in Healthy Participants. Diabetes Obes Metab. 2026;28(9):8128–8135. PubMed.
- Chen Z, Du C, Cai L, et al. No dose adjustment required for warfarin or metformin when coadministered with the novel GLP-1 receptor agonist ecnoglutide: an open-label, fixed-sequence, crossover study. Front Pharmacol. 2026;17:1816593. PubMed.
- Sciwind Biosciences. Sciwind Biosciences Announces Ecnoglutide Injection Approved by China’s National Medical Products Administration (NMPA) for Adult Type 2 Diabetes. January 30, 2026. Sciwind.
- Sciwind Biosciences. Sciwind Biosciences Partners with Pfizer China to Commercialize its Biased GLP-1 in China. February 24, 2026. Sciwind.
- Sciwind Biosciences. Sciwind Biosciences Announces Ecnoglutide Injection Approved by China’s National Medical Products Administration (NMPA) for Chronic Weight Management. March 6, 2026. Sciwind.
- Sciwind Biosciences. Head-to-head Study Validates the Clinical Advantage of New-generation Biased GLP-1: Ecnoglutide Delivers 35% Greater Weight Loss than Semaglutide. June 8, 2026. Sciwind.
- Sciwind Biosciences. EASD 2026 | Ecnoglutide Demonstrates Favorable Safety Profile in Adolescents with Obesity. September 30, 2026. Sciwind.
- ClinicalTrials.gov. Ecnoglutide and VRB-101 trial registrations: NCT04389775, NCT07143227, NCT07073417, NCT07281937, NCT07553299, NCT07836270, NCT07387094, NCT07434050, NCT07734311, NCT07243171.
- Code of Federal Regulations. 21 CFR 1308.13, Schedule III. eCFR.
- World Anti-Doping Agency. World Anti-Doping Code International Standard: Prohibited List 2026. WADA 2026 Prohibited List.