Ecnoglutide
A once-weekly GLP-1 analogue built to favour one signalling pathway, approved in China in 2026 for type 2 diabetes and weight management
Ecnoglutide (XW003) is a weekly GLP-1 analogue from Sciwind Biosciences, engineered to trigger the receptor's cAMP signal while barely internalising it. In a 40-week phase 3 trial in 664 Chinese adults with overweight or obesity, the top dose reduced weight by 13.2%. China approved it for type 2 diabetes and weight management in 2026.
What is it?
Ecnoglutide was chosen from a series of GLP-1 analogues with an alanine-to-valine change at position 8 and a fatty-acid chain. In cell assays it raised cAMP potently without driving the receptor inside the cell, a bias its developers hoped would sustain its effect. Its steady-state half-life in phase 1 was 124 to 138 hours.
In the phase 3 obesity trial, 664 adults without diabetes took 1.2, 1.8 or 2.4 mg weekly or placebo for 40 weeks; weight fell 9.1%, 10.9% and 13.2% against a 0.1% gain on placebo, and 87% on the top dose lost at least 5%. Adverse events, mostly mild gastrointestinal ones, affected 93% on ecnoglutide against 84% on placebo.
In type 2 diabetes it lowered HbA1c by about 2% as monotherapy and slightly more than dulaglutide on metformin. Pooled, three placebo-controlled diabetes trials showed a clear dose response between 0.4 and 1.2 mg. Interaction studies with warfarin, metformin, rosuvastatin and digoxin found no need to adjust doses.
The diabetes trials fill in the detail. In phase 2, 71.9% on 1.2 mg reached HbA1c of 6.5% or less after 20 weeks, against 9.1% on placebo. Against dulaglutide on metformin, 1.2 mg was statistically better at 32 weeks, though the difference, 0.24 points, was small; reductions held to week 52, and only 3% to 4% stopped for adverse events. In rodents it lowered weight more than semaglutide.
China's regulator approved ecnoglutide for type 2 diabetes on January 30, 2026 and for chronic weight management on March 6, 2026, according to Sciwind. It has no FDA or EMA approval.
Mechanism of Action
Ecnoglutide is a once-weekly GLP-1 analogue biased toward cAMP signalling, with an alanine-to-valine change at position 8 and a fatty-acid chain for a long half-life.
GLP-1 receptor, cAMP-biased
Raises cAMP potently (EC50 0.018 nM) without driving receptor internalisation in cell assays.
Appetite and glucose
Lowers HbA1c, fasting and post-meal glucose, and body weight, as the class does.
Weekly dosing
Steady-state half-life of 124 to 138 hours in phase 1.
Published Research
The studies of ecnoglutide, read from their PubMed abstracts; all trials ran in China.
Phase 3 weight trial: 664 adults
At week 40, weight changed by -9.1%, -10.9% and -13.2% on 1.2, 1.8 and 2.4 mg against +0.1% on placebo (differences -9.2% to -13.3%); 77%, 84% and 87% lost at least 5% of their weight against 16%.
Monotherapy in type 2 diabetes
In 211 adults, HbA1c fell by 1.96% on 0.6 mg and 2.43% on 1.2 mg over 24 weeks against 0.87% on placebo (differences -1.09% and -1.56%).
Against dulaglutide on metformin
In 621 adults over 32 weeks, HbA1c fell by 1.91% and 1.89% on ecnoglutide 0.6 and 1.2 mg against 1.65% on dulaglutide 1.5 mg.
Phase 2 in type 2 diabetes
In 145 adults, 20 weeks of 0.4, 0.8 or 1.2 mg lowered HbA1c by 1.81%, 1.90% and 2.39% against 0.55% on placebo.
Discovery and phase 1
Ecnoglutide raised cAMP potently (EC50 0.018 nM) without receptor internalisation and, in phase 1, was well tolerated for up to 6 weeks with a steady-state half-life of 124 to 138 hours.
Interactions: rosuvastatin and digoxin
In 28 healthy volunteers, ecnoglutide did not change rosuvastatin or digoxin exposure to a clinically relevant degree (digoxin AUC 84% of baseline), and weight fell 11.2% over the 14 weeks.
Interactions: warfarin and metformin
Co-administration did not alter total exposure to metformin or either warfarin enantiomer, and INR was unaffected; peak levels fell modestly and were delayed.
Dose and time response in diabetes
Across three trials and 977 participants, HbA1c fell 1.40 points and weight 2.16 kg more than on placebo, with clear dose dependence from 0.4 to 1.2 mg; adverse events were more common but serious ones were not.
Meta-analysis of four diabetes trials
Across four trials and 1,643 participants, ecnoglutide lowered HbA1c, weight and fasting glucose against all comparators combined, with mostly mild gastrointestinal events and no rise in serious adverse events.
Dosing Data
Trials gave it once weekly under the skin: 0.6 or 1.2 mg in type 2 diabetes and 1.2 to 2.4 mg for weight.
Educational information, not medical advice. Each dose above is tagged with its source: an approved label, a published human study, animal data, or amounts reported by users. None is a recommendation for you. An unapproved compound has no established safe or effective human dose, and products sold for “research use only” are not made or tested for people. Talk to a doctor before acting on anything on this site, including before you start, stop or change any medicine or dose. Full medical disclaimer.
Side Effects & Contraindications
Reported Side Effects
From the trials above.
Contraindications & Cautions
No Chinese label was read for this page. These cautions follow from the evidence.
Legal Status
Ecnoglutide is approved in China, for type 2 diabetes and for weight management, and not in the US or the EU.
Frequently Asked Questions
?What makes ecnoglutide different?
It was designed to activate the GLP-1 receptor's cAMP signalling strongly while barely internalising the receptor.
?How much weight did people lose?
In the 40-week phase 3 trial, 9.1% to 13.2% depending on dose, against a 0.1% gain on placebo.
?Where is ecnoglutide approved?
In China, for type 2 diabetes since January 2026 and for weight management since March 2026. FDA and EMA have not approved it.
?Does it interact with other medicines?
Four interaction studies found no need to adjust warfarin, metformin, rosuvastatin or digoxin. Peak levels of some of those drugs fell slightly and came later, but total exposure and warfarin's effect on clotting did not change.
?How does it compare with dulaglutide?
In 621 adults on metformin, ecnoglutide 0.6 and 1.2 mg lowered HbA1c by 1.91 and 1.89 points at 32 weeks against 1.65 on dulaglutide 1.5 mg. Both doses were non-inferior, and 1.2 mg was statistically superior, by a small margin.
?What side effects were reported?
Mostly gastrointestinal and mild to moderate. In the obesity trial, 93% on ecnoglutide had at least one adverse event against 84% on placebo; in phase 1, decreased appetite, nausea and headache were the common ones.
?What does cAMP-biased mean?
When a GLP-1 drug binds its receptor, the receptor both sends a cAMP signal and gets pulled inside the cell. In cell assays ecnoglutide triggered cAMP at very low concentrations but almost no receptor internalisation; its developers hoped that would keep the receptor available and sustain the effect.
?What doses were studied?
Once-weekly injections of 0.4 to 1.2 mg in type 2 diabetes, and 1.2, 1.8 and 2.4 mg in the phase 3 weight trial, with weight loss rising with dose.
References
- [pubmed] Ji L, 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. PMID: 40555243.
- [pubmed] Zhu D, 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. PMID: 41501026.
- [pubmed] He Y, 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. PMID: 40854315.
- [pubmed] Zhu D, 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. PMID: 39333121.
- [pubmed] Guo W, et al. "Discovery of ecnoglutide - A novel, long-acting, cAMP-biased glucagon-like peptide-1 (GLP-1) analog." Mol Metab, 2023;75:101762. PMID: 37364710.
- [news-release] Sciwind Biosciences. Ecnoglutide injection approved by China's NMPA for adult type 2 diabetes (PR Newswire, January 30, 2026) and for chronic weight management (PR Newswire, March 6, 2026). Read September 30, 2026.
- [fda] FDA. Drugs@FDA (openFDA): no application for ecnoglutide. Read September 30, 2026.
- [other] European Medicines Agency. Medicines register: no entry for ecnoglutide. Read September 30, 2026.
- [pubmed] Li F, 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. PMID: 42310888.
- [pubmed] Chen Z, 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. PMID: 42137314.
- [pubmed] Feng Y, et al. "Dose-response and time-course effects of ecnoglutide in type 2 diabetes: a systematic review and meta-analysis of efficacy." Front Endocrinol (Lausanne), 2026;17:1934027. PMID: 42798476.
- [pubmed] Kumar M, et al. "Comparative Efficacy and Safety of Ecnoglutide in Type 2 Diabetes: A Systematic Review and Meta-Analysis." Endocrinol Diabetes Metab, 2026;9(3):e70217. PMID: 41937314.
Sources & Citations
Studies were read from their PubMed abstracts; the Chinese approvals come from Sciwind's announcements. Read October 6, 2026.
Medical Disclaimer: This content is for educational and informational purposes only. It is not medical advice, and nothing here is an instruction to obtain or use any compound. Talk to a licensed clinician about your own situation.