Ecnoglutide produced more weight loss than semaglutide at 20 weeks in a small China trial

Researchers presented an early comparison of ecnoglutide and semaglutide at the American Diabetes Association conference in June 2026.

The late-breaking abstract reported 12.8% average weight loss with ecnoglutide at week 20. Average weight loss was 9.5% with semaglutide.

The SLIMMER-UP-SWITCH trial enrolled 163 adults with obesity at 17 research centers in China. Researchers randomly assigned them in equal groups to weekly injections of either drug. Both groups increased their dose toward 2.4 mg. The full trial runs for 60 weeks, so the week 20 results are interim findings.

The sponsor reported that 99% of the ecnoglutide group lost at least 5% of body weight. The corresponding figure was 86% with semaglutide. At least 10% weight loss occurred in 74% and 40% of participants, respectively.

Average waist size fell by 10.5 cm with ecnoglutide and 8.7 cm with semaglutide. The sponsor described digestive side effects as favorable. However, its quoted discontinuation figures came from an earlier study, not this interim comparison.

Ecnoglutide is designed to activate the GLP-1 receptor differently from semaglutide. Researchers call this cAMP-biased signaling. The trial does not show whether that laboratory design explains the weight-loss result.

China approved ecnoglutide for type 2 diabetes in January 2026 and for weight management in March. It is not approved in the United States, United Kingdom, or European Union. The main results came from the trial sponsor, Hangzhou Sciwind Biosciences, rather than an independent analysis.

The 20-week result supports a longer comparison

Both groups targeted 2.4 mg each week. However, equal milligram doses of different drugs do not represent equal biological strength. The result therefore does not show that ecnoglutide gets more effect from an equivalent dose. It also does not establish lower cost or fewer side effects.

Ecnoglutide is approved in China but not in the United States, United Kingdom, or European Union. The interim result does not change which drugs are approved elsewhere. It also does not establish a treatment change for clinicians outside China.

The 20-week result is not a final comparison

The trial is small, phase 2, and open-label. Participants and researchers knew which drug each person received. That knowledge can affect reported side effects and behavior around eating or activity.

Twenty weeks is early in a 60-week trial. Semaglutide was also near the end of its dose increases, so neither drug had much time at its target dose. All participants lived in China, which limits how broadly the results apply.

The findings appear in a conference abstract, not a full peer-reviewed paper. The sponsor reported the percentages, and no cardiovascular or long-term safety results are available.