China's ecnoglutide clears a phase 3 diabetes trial, on a small base

Ecnoglutide, a once-weekly GLP-1 receptor agonist developed in China, has cleared a phase 3 diabetes trial: in EECOH-1, the drug lowered glycated haemoglobin (HbA1c) by up to 1.56 percentage points more than placebo over 24 weeks [s1]. The reduction is competitive with established GLP-1 agonists, but the trial is small — 211 patients — short, placebo-controlled rather than head-to-head, and run entirely in one country by the drug's manufacturer [s1].

What EECOH-1 tested

Ecnoglutide is described by its developer, Sciwind Biosciences, as a "cAMP signalling-biased" GLP-1 analogue — engineered to favour one branch of the receptor's downstream signalling [s1]. EECOH-1 was a randomised, double-blind, placebo-controlled phase 3 trial in adults with type 2 diabetes inadequately controlled by diet and exercise alone, or by a single oral glucose-lowering drug [s1]. The primary endpoint was the change in HbA1c from baseline to week 24 [s1].

Between 29 December 2022 and 12 June 2024, 211 participants at 32 centres in China were randomised 2:2:1:1 to once-weekly subcutaneous ecnoglutide 0.6 mg (n=69) or 1.2 mg (n=71), or a volume-matched placebo (0.6 mg n=36; 1.2 mg n=35), for 24 weeks [s1]. Assignment was stratified by baseline HbA1c above or below 8.5% [s1]. The trial is registered as NCT05680155 [s1].

The numbers

At week 24, the least-squares mean HbA1c change was −1.96% (95% CI −2.18 to −1.73) on ecnoglutide 0.6 mg and −2.43% (95% CI −2.65 to −2.20) on 1.2 mg, against −0.87% (95% CI −1.09 to −0.65) on placebo [s1]. The estimated treatment differences versus placebo were −1.09 percentage points (95% CI −1.40 to −0.77; p=0.0003) at the lower dose and −1.56 (95% CI −1.87 to −1.24; p<0.0001) at the higher one [s1]. Both doses beat placebo comfortably, and the effect was dose-dependent [s1].

An HbA1c reduction of that size is in the range other weekly GLP-1 agonists reach, but EECOH-1 did not test the drug against any of them — the comparator was placebo. The manufacturer has run that comparison separately: in EECOH-2, a 52-week open-label phase 3 trial, ecnoglutide was tested against dulaglutide, an established weekly GLP-1 agonist, under a non-inferiority design [s2]. That active-comparator evidence, rather than a placebo trial, is the more informative test of where the drug sits, and reading the two together matters more than either alone.

What the trial does not establish

The limits are worth stating plainly. With 211 participants over 24 weeks, EECOH-1 is small and short by the standards of the diabetes GLP-1 field, where pivotal trials often run into the thousands and to a year or more [s1]. It was conducted only in China, so how the result generalises to other populations is untested here [s1]. It measured HbA1c, a surrogate; it was not designed to assess cardiovascular events, and none of these incretin agents can be assumed to carry a cardiovascular benefit without a dedicated outcomes trial [s1]. And it was funded by Sciwind, with several authors employed by the company [s1] — the trial data are peer-reviewed, but the development framing is the manufacturer's.

Where it stands

The regulatory milestones have moved ahead of the long-term evidence. Ecnoglutide received its first approval in China in January 2026, for glycaemic control in adults with type 2 diabetes, and a second approval there in March 2026 for long-term weight management in adults with obesity or overweight with a related complication [s3]. An oral formulation, and trials in adolescents and in obesity with sleep apnoea or knee osteoarthritis, are in development [s3].

What EECOH-1 adds is a clean, placebo-controlled confirmation that the drug lowers blood glucose in type 2 diabetes [s1]. What it leaves for larger and longer trials is how ecnoglutide compares head to head against the incretin drugs already in wide use, how it performs beyond 24 weeks and outside China, and whether it does anything for cardiovascular risk.

This article is informational and does not constitute medical advice.

Sources

• [s1] 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. Nature Communications, 7 January 2026. https://doi.org/10.1038/s41467-025-68165-7
• [s2] 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. The Lancet Diabetes & Endocrinology, 22 August 2025. https://doi.org/10.1016/S2213-8587(25)00196-2
• [s3] Ecnoglutide: First Approvals. Drugs (Adis), 7 July 2026. https://doi.org/10.1007/s40265-026-02350-w