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Change history 28 February 2025 The original online version of this article was revised to correct the names of the authors to Carlos Dieguez, Miguel Lpez, Felipe Casanueva

Who responds best to CagriSema Ideal candidates: Significant obesity (BMI 30-40+) Previously plateaued on GLP-1s alone Need maximum weight loss Good GI tolerability Metabolic syndrome or diabetes Commitment to long-term use Excellent responders: Higher baseline weight (more to lose) Good adherence to protocol Combine with diet/exercise Younger patients (better metabolism) No significant medication interactions May respond less optimally: Very low starting weight (BMI 30%): Nausea (most common) Decreased appetite (intended effect) Constipation Fatigue (especially first months) Common (10-30%): Vomiting (if nausea not managed) Diarrhea (alternating with constipation) Abdominal pain/discomfort Headache Dizziness Less common ( 40 with comorbidities Insurance covers surgery Want permanent solution Don't want ongoing injections Sourcing cagrilintide and semaglutide Obtaining these peptides requires understanding current availability

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PLoS One 8, 71150 (2013)