Tirzepatide's clinical efficacy was validated through the extensive global SURPASS (type 2 diabetes) and SURMOUNT (obesity) Phase 3 registration trial programs. In the landmark SURPASS-2 trial (Frías et al., NEJM 2021), 1,879 patients were randomized to receive once-weekly tirzepatide (5 mg, 10 mg, or 15 mg) versus semaglutide 1.0 mg. At week 40, mean HbA1c reductions were -2.01%, -2.24%, and -2.30% for tirzepatide compared to -1.86% for semaglutide 1.0 mg (p < 0.001 for all comparisons).
Body weight reductions were substantially greater with tirzepatide: -7.6 kg (5 mg), -9.3 kg (10 mg), and -11.2 kg (15 mg) versus -5.7 kg for semaglutide 1.0 mg. Furthermore, in the SURMOUNT-1 trial (Jastreboff et al., NEJM 2022) in 2,539 adults with obesity or overweight without diabetes, the 15 mg dose of tirzepatide produced a mean weight reduction of 20.9% (-23.6 kg) at 72 weeks, with 63% of participants achieving a ≥20% reduction.
In addition to weight and glycemic endpoints, tirzepatide elicited substantial reductions in circulating triglycerides (down 24-31%), VLDL, and fasting insulin, while elevating HDL cholesterol by 7-11%, substantiating comprehensive cardiometabolic risk reduction.