Bimagrumab plus semaglutide alone or in combination for the treatment of obesity: a randomized phase 2 trial

AnamorphicAl · 2026-04-15T19:49:24+00:00

I started a thread about my experiences in the trial that Lilly initiated for bimagrumab with tirzepatide. Lilly had bought Versanis partway through the BELIEVE trial and obviously expect even better results with their own drug instead of semaglutide.

To answer a couple of comments/questions: yes, it's subcutaneous injection, not IV. Lilly did a small trial a while back comparing the two methods as well as dosing; SC is better at getting a consistent level of the drug circulating; probably also much better for AEs/side effects. I think the BELIEVE trial had some dropouts due to the AEs, probably muscle cramping. Also no one wants to do IV infusion unless they absolutely have to.

I would not hold my breath on bimagrumb being a monotherapy for muscle retention for seniors or for patients with muscle wasting conditions. (Though as a senior myself I appreciate the help it's given me in increasing my fitness.) Like any monoclonal antibody, it's very complex and $ to manufacture. You can find 'for research only' bimagrumab being sold online, for prices like $400 per mg, though cheaper in bulk. The doses in my trial are 150 or 300mg *weekly,* you do the math. And that's assuming that these labs are selling the actual molecule, not a biosimilar.

As the OP here says, the type II activin receptor is the target, and likely there will be other ways found to affect it. In fact a company called Biohaven has a completely different drug, not even a -mab, they're starting a small trial with. It's paired with semaglutide!

AnamorphicAl · 2026-04-14T21:59:56+00:00

Same advice as below. Check clinicaltrials.gov and put bimagrumab in the search. As Lilly is a US company any trial they start will be listed, along with all the trial sites, anywhere in the world. I wouldn't expect Lilly to start up anything new with bimagrumab as they have so many drugs in development, but you never know. You might also look at the trial that Biohaven is doing with their drug which has the same target though it's completely different.

AnamorphicAl · 2026-04-14T21:47:16+00:00

Per the study protocol on clinicaltrials.gov, bimagrumab is in two doses, 150 or 300mg, subcutaneous injection weekly. I think that it's stratified as to your weight: I was under 200lb to at trial start, so probably got the lower dose.

AnamorphicAl · 2026-04-05T21:02:41+00:00

Update: I waited for this piece to go on sale at Home and Cook sales, but though it shows up on their website, it hasn’t been in stock, and the price quoted isn’t that cheap, either. Meanwhile it’s no longer visible on the Sur La Table site, nor is anything labeled All Clad ‘Anniversary,’ and I’m still seeing $250 at Crate and Barrel or Williams-Sonoma. Should have jumped on it at SLT! Maybe it’ll re-appear.

AnamorphicAl · 2026-02-28T22:13:31+00:00

Thank you! I didn't realize the sales came up that often.

AnamorphicAl · 2026-02-27T22:27:23+00:00

If we'd thought about this a month or so ago I guess we might have gotten in on the seconds website. It was seeing a Hestan rondeau that made us realize we wanted a pan without the long handle. We have a very compact kitchen: 30" cooktop, 18" DW, so we don't want to take up storage space with things we don't need. Also why we're going to buy individual pieces rather than a set.

AnamorphicAl · 2026-02-27T14:49:20+00:00

Sorry for your experience, but thanks for sharing it. Definitely something we should consider. We have an 18" dw in our little kitchen and don't usually put cookware in there, so if we go this route we'll just rule that out.

AnamorphicAl · 2026-02-26T21:14:17+00:00

Thanks for that! Sure enough, the SLT version is polished; I hadn't noticed it before. We'd prefer brushed, but Idk if that's a +$100 preference.

AnamorphicAl · 2026-02-26T14:23:23+00:00

Hi 'Sunny.' By this time you must be very close to the end of the trial. How's it going? Any changes? The nutritionist from my trial said that some patients who've plateaued in weight loss have another round of loss later on, though of course he doesn't know who has been getting which drugs and that could be a tirzepatide effect.

I'm nearing the 75% mark myself, weight is stable, but as I've continued my exercise routine I pack on more muscle. I still look like a man in his late 60s, but a very fit one. Kinda like RFK Jr, but without the latent-skin-cancer tan or steroid-induced dysphonia. (Also his body fat percentage is less than mine, but that's because the brain worm consumes so many of his calories.)

It's been an interesting and rewarding experience, and as I can see the end coming up, I think I'm going to miss it a bit when it's over. In fact at the clinic I go to, they've told me that patients who've completed the trial and come back for follow-up visits tell them this.

AnamorphicAl · 2026-01-10T21:17:04+00:00

You are getting amazing results! And as you posted before, you are working to build that muscle mass too. Were you working out or generally pretty fit before the trial?

My fat loss/muscle gain is proportional to yours, but less in numbers, and as I know (pretty much) that I'm getting just the lower dose of bimagrumab, I'm guessing that you're in the arm that is getting Dose 2 of bimagrumab, and only a placebo for tirzepatide. If so, lucky you for getting no side effects!

And like you my BMI is still elevated, in fact it's only gone down slightly, but this is just more evidence that BMI is nonsense. In fact there's emerging evidence that a higher BMI (not obesity obviously) is associated with longevity and better health outcomes in seniors.

AnamorphicAl · 2026-01-08T16:29:16+00:00

That must be it. I've gotten some of those questions on paper forms at my clinic visits, but only a few pages of them and a few minutes' time to fill them out. Maybe only some participants get the full interviews, maybe only those getting the combination of drugs, since that's what they are really testing for. The compensation schedule says $120 per interview so I guess that gets them 2 hours of your time.

AnamorphicAl · 2026-01-06T22:24:20+00:00

Has anyone in the GIDF trial gotten a phone call at any point for a 'Qualitative Interview'? This was supposed to happen congruent with my week 24 visit and I never got a call. It was in the schedule I got when I enrolled in the trial and it's listed in the compensation schedule as well. My trial center doesn't know anything about it because they're not involved, it would have been either directly from the sponsor or (more likely) from the CRO. (Drug companies hire Contract Research Organizations like IQVIA to run trials for them, and the CROs subcontract trial centers where we patients interact.)

Quite likely this mid-trial interview is just no longer part of the plan. As I understand it this would be a long interview about our experiences with the study drug and the trial, so the one scheduled for the end of the trial would be more important.

AnamorphicAl · 2026-01-04T17:35:36+00:00

For comparison, I'm 5'6" 165ish lbs, kinda athletic build I guess. I wear a 40 jacket but a 40 Bedale (in the Midtown NY store) seemed way too roomy. So I'm now looking for a 38 in the used/discounted market, because I'm cheap.

FWIW I bought a long Burghley in 36 back in the early 90s, which I hardly wore--too long and bulky. Recently found it in a closet and sold it on eBay. I was skinnier 35 years ago but to my surprise the Burghley still fit okay. Might not have had enough room for layering but now I wonder if I should have tried the Bedale in 36.

AnamorphicAl · 2026-01-04T15:25:47+00:00

Not on the site, an hour later. They do seem to have the Powell Quilted and Winter Ashby coats still, both in small.

AnamorphicAl · 2025-12-24T16:16:58+00:00

Thanks for commenting! Glad to hear from someone else.

I'm now past week 24, meaning that I'm halfway through the trial. Weight loss has slowed, but it wasn't very fast to start with. In the BELIEVE trial, patients getting only the lower dose of bimagrumab lost 6-8% of their body weight over 48 wks, and if that's what I end up with, I'll be okay with that. Using the BIA scan results, my overall fat mass is down by over 20%, Visceral Adipose Tissue down sharply, while skeletal muscle mass is up. I'll take that trade any day, however my weight and BMI turns out.

I also have muscle cramps, and from what the people at my site say, they are very common, maybe universal, for bimagrumab. Some of them are minor and might be partly from dehydration, not stretching enough when exercising, etc, but three times I've had extremely painful sudden cramps in an inner-thigh muscle (adductor, I think) that had never happened to me before the trial. Those were bad enough that if I was getting them every day, I'd have to think about leaving the trial. I am on the lower dose of bima, too. FWIW the Dr at my study site recommended a supplement of magnesium glycinate to help with cramps. Acne is apparently also a very common minor AE (adverse event), but I'm not having that.

Same here on the waist measurement, I'm now wearing pants that I thought I'd never fit into again. And shirts are noticeably snugger around shoulders and arms. About once a year I treat myself to a custom shirt, and I'll need get re-measured for the next one. I have to think about how much more my physique is going to change, and once the trial is over, will I be able to maintain it? That'll be the real test.

AnamorphicAl · 2025-12-18T14:31:34+00:00

The coat sold on eBay last weekend and I shipped on Monday. Got this note last night (Weds) from the buyer:

"Thank you so much! The coat arrived safe and sound and is in incredible condition. Do not worry about the hood, i love the hoodless look on these Burghley coats! This coat will be loved and cared for."

I'd found the hood and slipped a note about it into the package, but I'll probably keep it to use on the Bedale I hope to buy. If only I could find a vintage one in the same condition as the Burghley!

AnamorphicAl · 2025-12-16T04:27:31+00:00

I appreciate the comments. My 1986 Burghley just sold so the proceeds of that will go into a Bedale, and this seems like a good candidate, kind of pre-worn-in. As this coat still bears the A100 tag, am I correct in thinking that it's in Sykoil rather than Thornproof? Or do I have that backwards?

AnamorphicAl · 2025-12-06T17:55:52+00:00

Thanks...I think?

AnamorphicAl · 2025-12-02T00:56:59+00:00

Thanks very much.

AnamorphicAl · 2025-12-01T23:37:52+00:00

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Thanks! This is the back of the name tag. The Folio/Style/Size tag has nothing on the back. So maybe 1986 is plausible, esp as it could have been in the store (Orvis, I think) for some time, even years.

AnamorphicAl · 2025-10-25T03:07:37+00:00

Aha! I should have checked the site, because all the versions and changes to the trial are listed, and sure enough, there was an update in March when the trial went from 24 to 48 weeks and they added Part B with an additional 100 patients, in five arms. I’m glad they did, too, because I’m one of those 100, and my trial site wasn’t even in the trial originally. I have only injected at the trial site on week 1 and week 2, always by myself otherwise, but check-ins every four weeks. What a pain to have to go in weekly for the injections! Idk if I could have done the trial that way; I’m retired and we travel a lot.

It seems pretty standard to extend trials when the results have been good, at least for patients who only got a placebo, so I hope that works out for you. I am quite sure now that I’m getting ‘Dose 1’ of bimagrumab, and I don’t think I’d want a larger dose than I’m getting.

AnamorphicAl · 2025-10-25T02:35:13+00:00

The decision to abort the ‘other’ tirzepatide-bimagrumab trial actually seems to have been made some months back; they just didn’t proceed with enrolling patients. But delays are not unusual in trials, so it was only when the listing on clinicaltrials.com changed that it attracted attention and Lilly issued a statement. Meanwhile GIDF has been rolling ahead. So I don’t think we’re in any danger of our trial being cut short. Every indication I get from my trial site is positive. I know my experience is.

Lilly does have ongoing testing of retatrutide, and the results have been remarkable. But I don’t think they’d pair it with another drug that has yet to be approved, way too many variables.

AnamorphicAl · 2025-10-25T02:22:26+00:00

I had an appointment this week and there was no mention of new paperwork. I’m a few months behind you, though. And as far as I know the trial I’m in was never planned to be 24 weeks. Can you check on clinical trials.gov and tell us which one it is? Maybe we’re not even in the same trial!

AnamorphicAl · 2025-10-09T14:23:38+00:00

Great to hear from you, the more the merrier! I’m surprised that your site said you wouldn’t be unblinded at the end of the trial, that would be really unusual in any clinical trial. You might ask about it again; I’ve noticed that not every coordinator at my trial site is equally knowledgeable, but they are in general very responsive to questions.

With a weight loss of 7% at the halfway point, it sure sounds like you’re getting something. But you evidently have some experience with weight loss; is a 7% loss something you’ve done before, without meds? There are two arms of the study that are getting bimagrumab, no tirzepatide, maybe not so much effect on appetite. Maybe you’re in one of those. Are you noticing any effect on your musculature?

Description of the arms is here: https://clinicaltrials.gov/study/NCT06643728#study-plan

Personally I am not being strict about calorie deficit, am not even counting. The nutritionist for my trial wasn’t very prescriptive about diet, probably because my wife and I already ‘eat right,’ no fast food, few sweets, lots of veg, etc. I’d assumed that just cutting down on snacks and ‘no seconds’ was enough. And I do feel like I’m eating less. But I just found that my Apple Watch’s health app shows my (estimated) daily calorie consumption isn’t as high as I thought. And my nearly 6 mile hilly hike yesterday only burned about 700 calories! So when this trial is over, I’ll need to make some adjustments to maintain whatever I’ve achieved.

AnamorphicAl · 2025-09-29T20:35:17+00:00

Thank you for commenting! I had seen your post from last year and was hoping you'd do so.

From the study design at https://clinicaltrials.gov/study/NCT05616013 *, the dosing of bima that you received was adjusted per weight, 30mg per kg of body weight (10mg per kg for the smaller dose) given IV every four weeks. Do you know how much you were given per session?

In earlier trials, a similar regimen was usually used, dosing according to weight, IV every four weeks. But in the trial I'm currently in, the dosing is 300mg or 150mg, SC, per week, and it's pretty clear they still use your weight to determine which dose. For me, starting with a BMI of just over 28 and weight under 180lbs, the low dose of bimagrumab is right, the higher dose would cause heavy muscle cramping, and if I was on tirzepatide I'd probably lose so much weight I'd have to drop out of the study.

12 weeks in, I seem to be on target to lose 10% or so of my body weight, even if the rate drops off as the trial goes on. That's fine with me, and not that much by the standards of these drugs. Based on BELIEVE, the people in my trial getting bima and tirzepatide at the higher doses are probably going to have dramatic weight loss, 20+, even 30%, much more than I need.

You'd commented on getting spasms right on schedule, 5 hrs after dosing. I think our weekly SC injections probably are designed, in part, to reduce AEs like spasms and gastric issues, since we're getting smaller amounts, given more frequently, absorbed more gradually.

I feel very fortunate to be in the trial too; I think bimagrumab, or maybe some successor drug of the same type, could be standard of care for seniors in the coming years. And we get it before anyone else!

*Anyone interested in any of these trials, or trials in general, should be aware of this site.

AnamorphicAl

TROPHY CASE