Yes, and the margin over semaglutide alone is 0.16 HbA1c points. REIMAGINE 2 randomized 2,713 people with type 2 diabetes across 30 countries [1]. It met its primary endpoint against semaglutide 2.4 mg. The interval runs −0.27 to −0.05, p=0.0035. That is a real win and a small one. What the earlier combination data looked like is in what a combination adds.
The margin, and what it costs
Both arms started at a baseline HbA1c of 8.2%. Over 68 weeks the combination fell 1.91 percentage points and semaglutide alone fell 1.75. Both are large reductions. The gap between them is what the second molecule bought.
Tolerability moved the other way. Adverse events were reported in 86.9% of the combination group against 81.2% on semaglutide 2.4 mg. Gastrointestinal disorders were commonest in every active arm, and placebo ran 70.5%. So a second injection costs roughly six percentage points of additional adverse events for sixteen hundredths of an HbA1c point.
On top of insulin, the comparator changes the question
REIMAGINE 3 added the combination to basal insulin in 274 adults whose diabetes was not controlled [2]. Falls were 2.33 and 2.10 percentage points at the two dose levels, against 0.66 on dose-matched placebo. Baseline HbA1c averaged 8.8%, and the trial ran 40 weeks.
Those are large numbers, and they answer a narrower question than they appear to. The comparator was placebo. No semaglutide-alone arm was included. So the trial establishes that adding this to insulin works, and says nothing about whether cagrilintide earns its place beside semaglutide. Insulin doses generally come down when a GLP-1 goes on. That adjustment is covered in what a GLP-1 replaces and in when blood sugar goes too low.
The other combination, and why its pool is unreadable
IcoSema puts weekly insulin icodec and semaglutide in one injection. A meta-analysis pooled two COMBINE trials covering 1,970 people [3]. HbA1c showed no significant difference, −0.37%, 95% CI −0.95 to 0.21, with heterogeneity at an I² of 98%.
At 98%, almost none of the disagreement between those trials is chance. One compared against weekly insulin icodec alone and the other against full basal-bolus therapy. That is reason enough for the answers to diverge. Weight fell 6.10 kg and systolic pressure 2.45 mmHg. Every cardiovascular benefit reported is a risk marker rather than an event, and the authors call the work hypothesis-generating.
What a buyer should take from three combination trials
None of this is purchasable. CagriSema and IcoSema are both unapproved, so no seller can quote a price. A seller invoking either name is borrowing a result it cannot supply.
When a price does arrive, the arithmetic is the one this desk applies to every add-on. What does the second component cost a month, against what it adds? On the endpoint REIMAGINE 2 was built to test, that is 0.16 points. It is a hard number to price. Two pages work that through: whether it is worth the price and what a month costs.