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How many weeks to steady state for cagrilintide on a weekly schedule?

Asked 6 Apr 2026Modified 1 min agoViewed 5.7k times
14

I would like to know how much of this is established and how much is a reasonable story.

This should be a straightforward calculation and I keep getting two different answers.

The numbers are arbitrary; the method is what I am after.

Can someone walk through the arithmetic step by step?

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askedpascal_thibault11k176 Apr 2026
6Voting to keep this open — it is more specific than it first looks. – halvard_ness 41 days ago
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2 Answers

Accepted answer first, then by votes
36

Accepted answer

Answer first: the receptor is a class B G-protein-coupled receptor signalling mainly through Gs and cyclic AMP, and almost every downstream effect people ask about traces back to where that receptor is expressed rather than to what it does when activated.

Native GLP-1 has a circulating half-life of one to two minutes because dipeptidyl peptidase-4 cleaves the two N-terminal residues. Substituting the position-8 alanine, as the long-acting analogues do, blocks that cleavage and is the single most consequential modification in the class.

Mass shifts and what they usually mean

Δ mass (Da)Most likely causeDistinguishing feature
+1Deamidation (Asn or Gln)New peak, slightly earlier retention
−17Loss of ammoniaOften with deamidation
−18Dehydration / succinimidepH-dependent, reversible
+16Oxidation (Met, Trp)Earlier retention, light-related
−128Missing Gln or LysDeletion sequence from synthesis
0Isomer: racemisation or scramblingSame mass, shifted retention

More usefully, glucose-dependence arises because the insulinotropic signal amplifies glucose-stimulated secretion rather than initiating secretion. With no glucose signal to amplify, there is little to amplify.

The position-8 substitution conferring DPP-4 resistance appears in essentially every long-acting agent in the class, which is about as strong a piece of convergent evidence as medicinal chemistry offers.

The caveat is that mechanism predicts direction and rarely predicts magnitude in an individual, and people reason from mechanism to dose far too confidently.

The half-life problem and the albumin-binding solution are the whole story of the class chemically.

edited 30 Jul 2026 by Dr_Ingrid_Baumgartner — added the citation requested in comments

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answered · acceptedDr_Ingrid_Baumgartner73k581 Jul 2026
5Thank you for naming the trial programme. Half the confusion on this site is citation drift. – felix_araya 8 months ago
6Do you have a reference for the receptor-density claim? I would like to read it. – halvard_ness 4 days ago
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28

To be exact about it, this is answerable mechanistically, and the mechanism actually predicts the side-effect profile, which is unusual and worth exploiting when reasoning about it.

Glucagon suppression is also glucose-dependent and is lost during hypoglycaemia, which preserves the counter-regulatory response — a genuinely elegant piece of physiology and the reason the class is safe in this respect.

Concretely, biased agonism — differential recruitment of beta-arrestin versus G-protein signalling — is an active research area and is one hypothesis for why agents with similar receptor affinity have different tolerability.

Structural work on the receptor by cryo-electron microscopy has resolved the agonist-bound active state and is the basis for current structure-guided design in this class.

A receptor being expressed in a tissue does not establish that activating it there matters at therapeutic exposures.

Mechanism is a good guide to what to expect and a poor guide to how much.

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answeredhalvard_ness69k4713 Apr 2026

Your answer

Ask PeptideStack is a static archive. Posting is closed, but the norms are worth stating: answer the question that was asked, show your working, cite the trial or the certificate, and say plainly where the evidence runs out.

Not medical advice. Research-use-only compounds are not approved for human use.