after signing the consent form, you are assigned a study number and placed into one of two groups by a computer system. the assignment is random, so you will receive either the study drug nnc0487-0111 (containing the active substance zenagamtide) or a matching placebo that looks identical but does not contain the active ingredient.

a series of examinations are performed before the first dose. these include a physical exam, measurements of weight and blood pressure, blood tests to evaluate kidney function (e.g., eGFR), and questionnaires about symptoms of heart failure. the purpose is to document your health status at the start of the study.

on the day of the first visit, a nurse or trained staff member gives you a subcutaneous injection (injected under the skin) using a pre‑filled pen. the injection contains either nnc0487-0111 or the placebo. the dose is defined by the study protocol and is administered once weekly. you will be observed for a short period after the injection to check for immediate reactions.

you will receive a subcutaneous injection of the assigned study product once every week for the duration of the trial, which may last up to three years. the injection is given at the study centre or, if approved by the protocol, at home using the same pre‑filled pen. each dose is identical in appearance, and you will not know whether it contains zenagamtide or is a placebo.

every month you will attend a follow‑up visit at the study centre. during these visits you will have your weight, blood pressure, and heart rate measured; blood samples will be drawn to monitor kidney function and other safety parameters; and you will complete questionnaires that assess quality of life and heart‑failure symptoms.

the staff will also ask about any hospitalisations, urgent visits for heart failure, or other health events that have occurred since the previous visit.

throughout the study, any adverse events, such as side effects or new medical problems, are recorded. special attention is given to events like cardiovascular death, hospitalisation for heart failure, or urgent heart‑failure visits, because these are the primary outcomes the study is evaluating.

additional laboratory tests may be performed at scheduled intervals to track kidney function (e.g., eGFR) and other safety markers.

when the predetermined study period ends or if you discontinue participation, a final visit is scheduled. during this visit the same examinations performed at baseline are repeated, including physical measurements, blood tests, and questionnaires.

the data collected will be used to compare the outcomes of participants who received nnc0487-0111 with those who received the placebo.