Stage Set for Mussorgsky's Pictures at an Exhibition

Did Tirzepatide Steal the Show at EASD?

At EASD this week, it was quite a showing for tirzepatide. Sold under the brand name Mounjaro, it’s already available for treating diabetes and it’s awaiting approval for treating obesity. Based on the research presented at EASD this week, semaglutide might be looking a little like old news. For tirzepatide, a total of 11 presentations came out at this meeting while semaglutide had only seven – and three of those were comparisons to tirzepatide. Not that we’re keeping score.

But three presentations in particular made the tirzepatide star shine bright this week: SURMOUNT-4, SURPSS-6, and a meta-analysis of tirzepatide and semaglutide RCTs.


This was the study that many folks in obesity research were waiting to see in detail. Lilly announced topline results for this 88-week study back in July. Finally yesterday, we got our first look at the detailed results in a symposium devoted entirely to this one study. Jens Holst summed it up in a discussion of the results:

“The immediate thing that you will notice is that this is a fantastic result. This is huge weight loss. It’s absolutely true that we are now approaching the results with bariatric surgery.”

The other thing to note is the trajectory of people who were switched to placebo after 36 weeks. At the end of 88 weeks, their weight was clearly higher than the active treatment group, but they were still 9.5% below their starting weight. John Wilding noted that about 15% of people who stopped tirzepatide after 36 weeks maintained 20% or greater weight loss.

So the question this begs is what the role might be for intermittent therapy.


For the SURPASS-6 study, we enjoyed both a detailed presentation at EASD and a full publication in JAMA this week. This was a study of tirzepatide in type 2 diabetes that was not adequately controlled with basal insulin. Patients were randomized to receiving tirzepatide weekly or insulin lispro with meals in addition to their basal insulin.

In sum, the people who received tirzepatide benefitted more, with better control of blood sugar and better weight outcomes. Quality of life was better with tirzepatide, not to mention that patients enjoyed having 20 fewer needle jabs per week.

A Network Meta-Analysis

In this intriguing study, researchers led by Thomas Karagiannis analyzed data from 22 RCTs of tirzepatide and semaglutide in 18,472 patients with type 2 diabetes. They found better control of blood sugar and better weight outcomes with tirzepatide.

So, yes, we do have good reason to think that tirzepatide stole the show at EASD 2023.

Click here for earlier reporting on SURMOUNT-4, here for the publication of SUPASS-6, and here for the abstract from Karagiannis et al. For further reporting on the Karagiannis study, click here.

Stage Set for Mussorgsky’s Pictures at an Exhibition, painting by Wassily Kandinsky / WikiArt

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October 6, 2023