Evidence reference only. Not medical advice, not a dosing guide, and not a recommendation to use any drug.
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Investigational and unapproved. Findings below describe what trials and reports have observed. Nothing here is an endorsement, a claim of safety or effectiveness, or a clinical recommendation.

Survodutide

INVESTIGATIONAL

GLP-1/glucagon (GCGR) dual agonist

16
graded findings
12
effect domains
Evidence spread
High evidence 0Moderate evidence 10Low evidence 3Very low evidence 3

Survodutide is shown as an investigational or pipeline evidence record. Findings describe what studies and reports observed; they do not endorse use or establish personal suitability.

Thin or bounded evidence here means uncertainty remains visible. It is not evidence that an effect has been ruled out.
Survodutide INVESTIGATIONAL
Blood pressure Decrease
Moderate evidence

Placebo-corrected reductions in systolic and diastolic BP at 4.8 mg

le Roux CW et al. Diabetes Obes Metab 2025 (post hoc, DOI 10.1111/dom.16052) Source
PopulationAdults with obesity, phase 2 post hoc analysis (n=387), 46 wk
Fundingindustry - Novo Nordisk (trial sponsor)
Scope limitspost-hoc (not prespecified)
Comparatorsplacebo
Survodutide INVESTIGATIONAL
Blood pressure Decrease
Low evidence

Survodutide reduced blood pressure (with waist circumference and triglycerides) in phase 2 obesity cardiometabolic analysis.

Survodutide phase 2 cardiometabolic, Eur Heart J, 2024;45(Suppl 1):ehae666.2895 Source
PopulationN=387 adults BMI >=27 without diabetes; survodutide 0.6-4.8 mg vs placebo; 46 weeks; phase 2.
Fundingindustry - Boehringer Ingelheim / Zealand (trial sponsor; inferred from registration trial)
Scope limitsconference/abstract-level
Comparatorsplacebo
Thin or bounded evidence here means uncertainty remains visible. It is not evidence that an effect has been ruled out.
Survodutide INVESTIGATIONAL
Lipids and lipoproteins Mixed
Moderate evidence

Reductions in total cholesterol, LDL-C, triglycerides; increase in HDL-C

le Roux CW et al. Lancet Diabetes Endocrinol 2024;12:162-173 Source
PopulationAdults with obesity, phase 2 (n=387), 46 wk
Fundingindustry-Boehringer Ingelheim
Scope limitsidentifier not fully verified
Comparatorsplacebo
Survodutide INVESTIGATIONAL
Lipids and lipoproteins Decrease
Low evidence

Survodutide reduced TG, total and LDL cholesterol and VLDL in phase 2 obesity; HDL relatively unchanged.

Survodutide phase 2 cardiometabolic, Eur Heart J, 2024;45(Suppl 1):ehae666.2895 Source
PopulationN=387 adults BMI >=27 without diabetes; survodutide 0.6-4.8 mg vs placebo; 46 weeks; phase 2.
Fundingindustry - Boehringer Ingelheim / Zealand (trial sponsor; inferred from registration trial)
Scope limitsconference/abstract-level
Comparatorsplacebo
Thin or bounded evidence here means uncertainty remains visible. It is not evidence that an effect has been ruled out.
Survodutide INVESTIGATIONAL
Gastrointestinal tolerability Increase
Moderate evidence

GI AEs (nausea, diarrhoea, vomiting) markedly more frequent than placebo; dose-dependent, titration-managed; high AE-related discontinuation, mainly GI.

Sanyal et al., Phase 2 Survodutide in MASH and Fibrosis, NEJM 2024; Boehringer phase 3 press Source
PopulationSurvodutide phase 2 (obesity/MASH); 48 weeks; s.c. 2.4/4.8/6.0 mg weekly vs placebo
Fundingindustry - Boehringer Ingelheim (disclosed in publication)
Scope limitsidentifier not fully verified; no outcome data yet (ongoing)
Comparatorsplacebo
Survodutide INVESTIGATIONAL
Gastrointestinal tolerability Increase
Moderate evidence

GI events dominant; higher than placebo

Sanyal AJ et al. A Phase 2 Randomized Trial of Survodutide in MASH and Fibrosis. N Engl J... Source
PopulationMASH (n=293) and obesity (n=387) phase 2 trials
Fundingindustry - Boehringer Ingelheim / Zealand
Scope limitsRapid dose escalation in MASH trial may drive higher GI rates
Comparatorsplacebo
Thin or bounded evidence here means uncertainty remains visible. It is not evidence that an effect has been ruled out.
Survodutide INVESTIGATIONAL
hepatic-mash Decrease
Moderate evidence

Survodutide (BI 456906; Boehringer/Zealand) is a GLP-1/glucagon dual agonist in phase 3 for obesity and MASH. In a 48-week phase 2 MASH trial, MASH improvement without...

Sanyal et al., Phase 2 Survodutide in MASH and Fibrosis, NEJM 2024; Boehringer phase 3 press Source
Full findingSurvodutide (BI 456906; Boehringer/Zealand) is a GLP-1/glucagon dual agonist in phase 3 for obesity and MASH. In a 48-week phase 2 MASH trial, MASH improvement without worsening fibrosis occurred in 47/62/43% (2.4/4.8/6.0 mg) vs 14% placebo; >=30% liver-fat reduction in 57-67% vs 14%; fibrosis (>=1 stage) improvement 34/36/34% (up to 36%) vs 22% placebo. A phase 2 obesity trial showed dose-dependent weight loss up to ~12% at 46 weeks; phase 3 reported 16.6% weight loss.
PopulationMASH: 293 adults, biopsy-confirmed MASH + fibrosis F1-F3, once-weekly s.c. 2.4/4.8/6.0 mg vs placebo, 48 wk; obesity phase 2: adults obesity/overweight, 46 wk
Fundingindustry - Boehringer Ingelheim (disclosed in publication)
Scope limitsidentifier not fully verified; no outcome data yet (ongoing)
Comparatorsplacebo
Survodutide INVESTIGATIONAL
hepatic-mash Decrease
Moderate evidence

In a 48-week phase 2 trial (biopsy MASH, fibrosis F1-F3), the GLP-1/glucagon dual survodutide was superior to placebo for histologic MASH improvement without fibrosis...

Sanyal AJ et al. A Phase 2 Randomized Trial of Survodutide in MASH and Fibrosis. N Engl J... Source
Full findingIn a 48-week phase 2 trial (biopsy MASH, fibrosis F1-F3), the GLP-1/glucagon dual survodutide was superior to placebo for histologic MASH improvement without fibrosis worsening, with a NON-monotonic (quadratic) dose-response peaking at 4.8 mg. Liver fat strongly separated; the fibrosis-improvement secondary favoured survodutide only modestly (34-36% vs 22%).
PopulationNCT04771273; N=293 dosed (survodutide 2.4/4.8/6.0 mg vs placebo); biopsy MASH fibrosis F1-F3; 48 wk (24-wk escalation then maintenance).
Fundingindustry - Boehringer Ingelheim / Zealand
Scope limitsDEEPENS the survodutide topline (this id) to PUBLISHED detail. SURROGATE caveat: histological surrogates, hard liver outcomes unproven. DISTINCTION: PRIMARY was MASH IMPROVEMENT without fibrosis worsening (does NOT require fibrosis improvement); the fibrosis-IMPROVEMENT signal (34-36% vs 22%) is a SEPARATE, weaker secondary - do not conflate. Non-monotonic dose-response. Sponsor Boehringer Ingelheim. Phase-3 (LIVERAGE) registered, no published results (registry-only). Reta relevance: survodutide is a GLP-1/glucagon DUAL sharing reta's glucagon arm, but reta has NO MASH histology trial - not transferable as if observed.
Comparatorsplacebo
Thin or bounded evidence here means uncertainty remains visible. It is not evidence that an effect has been ruled out.
Survodutide INVESTIGATIONAL
Cardiovascular outcomes Not directional
Moderate evidence

ABSENCE OF EVIDENCE: as of the 2026-06-21 (non-exhaustive) sweep, no powered hard-endpoint CV outcome trial has REPORTED for any GLP-1/glucagon dual agonist; the class...

Absence established via PubMed sweep (2026-06-21): no dual-agonist CV-outcome-trial recor... Source
Full findingABSENCE OF EVIDENCE: as of the 2026-06-21 (non-exhaustive) sweep, no powered hard-endpoint CV outcome trial has REPORTED for any GLP-1/glucagon dual agonist; the class sits in the phase-2/early-phase-3 era with weight, glycaemic, hepatic (MASH) and CV-risk-factor readouts only. This absence is NOT reassurance: the glucagon arm's CV-risk hypothesis has never been tested at hard-endpoint level in any agent, so the net effect is UNMEASURED, not measured-and-null. It is an evidence GAP, not a demonstration of CV neutrality or harm, and does not exclude ongoing/unreported trials.
PopulationClass-level absence statement (cotadutide, survodutide, mazdutide, pemvidutide, efinopegdutide); efficacy/surrogate data only; no dedicated CVOT reported.
Fundingacademic / non-commercial (De Fano GIP review; no industry sponsor; disclosed)
Scope limitsanimal data; human relevance uncertain; surrogate/exploratory endpoint
Thin or bounded evidence here means uncertainty remains visible. It is not evidence that an effect has been ruled out.
Survodutide INVESTIGATIONAL
heart-rate-chronotropy Increase
Moderate evidence

In the phase 2 obesity dose-finding trial (NCT04667377), survodutide raised heart rate by a mean ~2.7 bpm (all doses pooled) versus ~0.1 bpm on placebo, with a...

le Roux CW et al., Diabetes Obes Metab 2024;27(2):993-996 (Letter; survodutide BP post hoc) Source
Full findingIn the phase 2 obesity dose-finding trial (NCT04667377), survodutide raised heart rate by a mean ~2.7 bpm (all doses pooled) versus ~0.1 bpm on placebo, with a post-hoc analysis reporting blood-pressure improvement; weight loss up to ~14.9% at 46 weeks.
Populationphase 2 obesity dose-finding trial (NCT04667377); post-hoc blood-pressure analysis (Letter)
Fundingindustry - Boehringer Ingelheim / Zealand (trial sponsor)
Scope limitspost-hoc (not prespecified); magnitude web/secondary-sourced
Comparatorsplacebo
Thin or bounded evidence here means uncertainty remains visible. It is not evidence that an effect has been ruled out.
Survodutide INVESTIGATIONAL
Body composition Decrease
Very low evidence

SYNCHRONIZE (phase 3) prespecified MRI substudy: survodutide reduced visceral adipose tissue ~34%, subcutaneous adipose tissue ~28% and lean body volume ~9.8%; fat...

Boehringer Ingelheim / Zealand, survodutide phase 2 MRI body-composition substudy (confer... Source
Full findingSYNCHRONIZE (phase 3) prespecified MRI substudy: survodutide reduced visceral adipose tissue ~34%, subcutaneous adipose tissue ~28% and lean body volume ~9.8%; fat mass ~78% / lean mass ~22% of total weight lost reported; lean tissue <=10.8% of total tissue-mass change at the highest dose.
PopulationPhase 2 obesity MRI substudy (survodutide / BI 456906); dose range to ~4.8 mg
Fundingindustry - Boehringer Ingelheim / Zealand
Scope limitsconference/abstract-level; no outcome data yet (ongoing)
Comparatorsplacebo
Thin or bounded evidence here means uncertainty remains visible. It is not evidence that an effect has been ruled out.
Survodutide INVESTIGATIONAL
Insulin and beta-cell function Decrease
Low evidence

GLP-1/glucagon dual agonists lower HbA1c in T2D phase 2 trials (survodutide -1.46% to -1.71% over 16 wk; mazdutide -1.41% to -1.67% over 20 wk vs placebo +0.03%), but...

survodutide: Blüher M et al., Lancet Diabetes Endocrinol 2024 (PMID:38095657); mazdutide:... Source
Full findingGLP-1/glucagon dual agonists lower HbA1c in T2D phase 2 trials (survodutide -1.46% to -1.71% over 16 wk; mazdutide -1.41% to -1.67% over 20 wk vs placebo +0.03%), but historically show modest or no glycaemic improvement (or even impaired glucose tolerance) when the glucagon weighting is too high — net glycaemia depends on maintained incretin dominance over the glucagon arm.
PopulationT2D phase 2 (survodutide BI 456906; mazdutide, Chinese cohort)
Fundingacademic/independent analysis (manufacturer not study sponsor; per-study COI not individually audited)
Scope limitsReused from corpus L2-030/L2-031/L2-032. Net glycaemia (not isolated insulin-sensitivity/beta-cell endpoint). Illustrates the glucagon-weighting balance relevant to retatrutide's offset.
Comparatorsplacebo
Thin or bounded evidence here means uncertainty remains visible. It is not evidence that an effect has been ruled out.
Survodutide INVESTIGATIONAL
Energy expenditure and thermogenesis Increase
Very low evidence

Weight loss driven by increased energy expenditure plus reduced food intake (preclinical)

Zimmermann T et al. Mol Metab 2022;66:101633 Source
PopulationMouse obesity models (preclinical pharmacology)
Fundingacademic/independent analysis (manufacturer not study sponsor; per-study COI not individually audited)
Scope limitsEE mechanism preclinical; human EE not directly quantified
Comparatorssemaglutide
Thin or bounded evidence here means uncertainty remains visible. It is not evidence that an effect has been ruled out.
Survodutide INVESTIGATIONAL
Pharmacology and mechanism Not directional
Very low evidence

Acylated (C18) GCGR/GLP-1R dual agonist, once-weekly; engages both receptors in vivo

Zimmermann T et al. Mol Metab 2022;66:101633 Source
PopulationIn-vitro + in-vivo preclinical
Fundingacademic/independent analysis (manufacturer not study sponsor; per-study COI not individually audited)
Comparatorssemaglutide
Thin or bounded evidence here means uncertainty remains visible. It is not evidence that an effect has been ruled out.
Survodutide INVESTIGATIONAL
Safety signals No change
Moderate evidence

Serious adverse events comparable to placebo; no safety signal attributed to glucagon receptor agonism

Sanyal AJ et al. A Phase 2 Randomized Trial of Survodutide in MASH and Fibrosis. N Engl J... Source
PopulationMASH phase 2 (n=293), 48 wk
Fundingindustry - Boehringer Ingelheim / Zealand
Scope limitsSYNCHRONIZE phase 3 CV outcomes trial ongoing
Comparatorsplacebo
Thin or bounded evidence here means uncertainty remains visible. It is not evidence that an effect has been ruled out.
Survodutide INVESTIGATIONAL
Weight change Decrease
Moderate evidence

Dose-dependent weight loss vs placebo over 46 weeks in obesity without diabetes

le Roux CW et al. Lancet Diabetes Endocrinol 2024;12:162-173 Source
PopulationAdults BMI ≥27 without diabetes (n=387), phase 2 dose-finding, 46 wk, RCT double-blind, placebo-controlled (NCT04667377)
Fundingindustry-Boehringer Ingelheim
Scope limitsidentifier not fully verified
Comparatorsplacebo