# Is tirzepatide more effective than semaglutide for glycaemic control in type 2 diabetes?

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**Summary:** In a head-to-head trial, tirzepatide lowered HbA1c and body weight more than semaglutide 1 mg, with a similar side-effect profile.

SURPASS-2 randomised 1,879 adults with type 2 diabetes inadequately controlled on metformin to once-weekly tirzepatide at 5, 10, or 15 mg or to once-weekly semaglutide 1 mg. At 40 weeks, all three tirzepatide doses produced greater reductions in HbA1c than semaglutide, and the comparison met criteria for superiority [1].

Weight reduction was also greater with tirzepatide across doses than with semaglutide 1 mg [1]. Tirzepatide is a dual GIP and GLP-1 receptor agonist, which is the mechanistic explanation usually offered for the difference.

Adverse events were predominantly gastrointestinal and broadly similar in character between the drugs, consistent with the incretin class as a whole [1].

## Limitations

- The comparator was semaglutide 1 mg; higher semaglutide doses licensed later were not tested, so this is not a comparison at maximum doses of both drugs.
- The trial measured glycaemic and weight endpoints over 40 weeks and was not designed or powered to compare cardiovascular outcomes.

## Sources

1. [IV / Randomised trial] Tirzepatide versus Semaglutide Once Weekly in Patients with Type 2 Diabetes. New England Journal of Medicine (2021). PMID 34170647. https://pubmed.ncbi.nlm.nih.gov/34170647/

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