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Study · Systematic review · n = 23,622 · 2024

18 results

Subcutaneously administered tirzepatide vs semaglutide for adults with type 2 diabetes: a systematic review and network meta-analysis of randomised controlled trials.

Karagiannis T, Malandris K, Avgerinos I, Stamati A, Kakotrichi P, Liakos A, Vasilakou D, Kakaletsis N, Tsapas A, Bekiari E

Diabetologia13 Apr 2024Cited by 79 (Europe PMC)

Summary

Aims/hypothesisWe conducted a systematic review and network meta-analysis to compare the efficacy and safety of s.c. administered tirzepatide vs s.c. administered semaglutide for adults of both sexes with type 2 diabetes mellitus.MethodsWe searched PubMed and Cochrane up to 11 November 2023 for RCTs with an intervention duration of at least 12 weeks assessing s.c. tirzepatide at maintenance doses of 5 mg, 10 mg or 15 mg once weekly, or s.c. semaglutide at maintenance doses of 0.5 mg, 1.0 mg or 2.0 mg once weekly, in adults with type 2 diabetes, regardless of background glucose-lowering treatment. Eligible trials compared any of the specified doses of tirzepatide and semaglutide against each other, placebo or other glucose-lowering drugs. Primary outcomes were changes in HbA1c and body weight from baseline. Secondary outcomes were achievement of HbA1c target of ≤48 mmol/mol (≤6.5%) or <53 mmol/mol (<7.0%), body weight loss of at least 10%, and safety outcomes including gastrointestinal adverse events and severe hypoglycaemia. We used version 2 of the Cochrane risk-of-bias tool (ROB 2) to assess the risk of bias, conducted frequentist random-effects network meta-analyses and evaluated confidence in effect estimates utilising the Confidence In Network Meta-Analysis (CINeMA) framework.ResultsA total of 28 trials with 23,622 participants (44.2% female) were included. Compared with placebo, tirzepatide 15 mg was the most efficacious treatment in reducing HbA1c (mean difference -21.61 mmol/mol [-1.96%]) followed by tirzepatide 10 mg (-20.19 mmol/mol [-1.84%]), semaglutide 2.0 mg (-17.74 mmol/mol [-1.59%]), tirzepatide 5 mg (-17.60 mmol/mol [-1.60%]), semaglutide 1.0 mg (-15.25 mmol/mol [-1.39%]) and semaglutide 0.5 mg (-12.00 mmol/mol [-1.09%]). In between-drug comparisons, all tirzepatide doses were comparable with semaglutide 2.0 mg and superior to semaglutide 1.0 mg and 0.5 mg. Compared with placebo, tirzepatide was more efficacious than semaglutide for reducing body weight, with reductions ranging from 9.57 kg (tirzepatide 15 mg) to 5.27 kg (tirzepatide 5 mg). Semaglutide had a less pronounced effect, with reductions ranging from 4.97 kg (semaglutide 2.0 mg) to 2.52 kg (semaglutide 0.5 mg). In between-drug comparisons, tirzepatide 15 mg, 10 mg and 5 mg demonstrated greater efficacy than semaglutide 2.0 mg, 1.0 mg and 0.5 mg, respectively. Both drugs increased incidence of gastrointestinal adverse events compared with placebo, while neither tirzepatide nor semaglutide increased the risk of serious adverse events or severe hypoglycaemia.Conclusions/interpretationOur data show that s.c. tirzepatide had a more pronounced effect on HbA1c and weight reduction compared with s.c. semaglutide in people with type 2 diabetes. Both drugs, particularly higher doses of tirzepatide, increased gastrointestinal adverse events.RegistrationPROSPERO registration no. CRD42022382594.
CC BYText from Europe PMC. Highlighted sentences are the source of results.

Results from this study18

18 results from studies that gave the peptide. 18 results from people.

  1. 01HumanSystematic reviewEfficacy outcome

    In adults with type 2 diabetes, tirzepatide 15 mg reduced HbA1c versus placebo and was the most efficacious treatment.

    In plain wordsIn adults with type 2 diabetes, tirzepatide 15 mg lowered HbA1c more than placebo and was the most effective option.

    Outcome
    DecreaseHbA1c change versus placebo, 15 mg
    Study

    n: not reported in source

    Comparator
    Placebo
    Analysis
    Primary
    Outcome group
    Glycemic control · Metabolic and weight
    Studied dose
    15 mg · subcutaneous · at least 12 weeksAs given in this study (human).

    Measurements

    Mean difference
    −21.61 mmol/mol
    15 mg vs placebo
    Mean difference
    −1.96%
    15 mg vs placebo

    Source sentences

    Summary
    Compared with placebo, tirzepatide 15 mg was the most efficacious treatment in reducing HbA1c (mean difference -21.61 mmol/mol [-1.96%])
    2 context sentences
    Summary · context
    Secondary outcomes were achievement of HbA1c target of ≤48 mmol/mol (≤6.5%) or <53 mmol/mol (<7.0%), body weight loss of at least 10%, and safety outcomes including gastrointestinal adverse events and severe hypoglycaemia.
    Summary · context
    A total of 28 trials with 23,622 participants (44.2% female) were included.
  2. 02HumanSystematic reviewEfficacy outcome

    In adults with type 2 diabetes, tirzepatide 10 mg reduced HbA1c versus placebo.

    In plain wordsIn adults with type 2 diabetes, tirzepatide 10 mg lowered HbA1c more than placebo.

    Outcome
    DecreaseHbA1c change versus placebo, 10 mg
    Study

    n: not reported in source

    Comparator
    Placebo
    Analysis
    Primary
    Outcome group
    Glycemic control · Metabolic and weight
    Studied dose
    10 mg · subcutaneous · at least 12 weeksAs given in this study (human).

    Measurements

    Mean difference
    −20.19 mmol/mol
    10 mg vs placebo
    Mean difference
    −1.84%
    10 mg vs placebo

    Source sentences

    Summary
    tirzepatide 10 mg (-20.19 mmol/mol [-1.84%])
    3 context sentences
    Summary · context
    Compared with placebo
    Summary · context
    Secondary outcomes were achievement of HbA1c target of ≤48 mmol/mol (≤6.5%) or <53 mmol/mol (<7.0%), body weight loss of at least 10%, and safety outcomes including gastrointestinal adverse events and severe hypoglycaemia.
    Summary · context
    A total of 28 trials with 23,622 participants (44.2% female) were included.
  3. 03HumanSystematic reviewEfficacy outcome

    In adults with type 2 diabetes, tirzepatide 5 mg reduced HbA1c versus placebo.

    In plain wordsIn adults with type 2 diabetes, tirzepatide 5 mg lowered HbA1c more than placebo.

    Outcome
    DecreaseHbA1c change versus placebo, 5 mg
    Study

    n: not reported in source

    Comparator
    Placebo
    Analysis
    Primary
    Outcome group
    Glycemic control · Metabolic and weight
    Studied dose
    5 mg · subcutaneous · at least 12 weeksAs given in this study (human).

    Measurements

    Mean difference
    −17.6 mmol/mol
    5 mg vs placebo
    Mean difference
    −1.6%
    5 mg vs placebo

    Source sentences

    Summary
    tirzepatide 5 mg (-17.60 mmol/mol [-1.60%])
    3 context sentences
    Summary · context
    Compared with placebo
    Summary · context
    Secondary outcomes were achievement of HbA1c target of ≤48 mmol/mol (≤6.5%) or <53 mmol/mol (<7.0%), body weight loss of at least 10%, and safety outcomes including gastrointestinal adverse events and severe hypoglycaemia.
    Summary · context
    A total of 28 trials with 23,622 participants (44.2% female) were included.
  4. 04HumanSystematic reviewEfficacy outcome

    In adults with type 2 diabetes, all tirzepatide doses lowered HbA1c comparably to semaglutide 2.0 mg and more than semaglutide 1.0 mg and 0.5 mg.

    In plain wordsIn adults with type 2 diabetes, tirzepatide lowered HbA1c about as much as the highest semaglutide dose and more than lower semaglutide doses.

    Outcome
    MixedHbA1c versus semaglutide
    Study

    n: not reported in source

    Comparator
    Semaglutide
    Analysis
    Primary
    Outcome group
    Glycemic control · Metabolic and weight
    Studied dose
    5, 10 and 15 mg · subcutaneous · at least 12 weeksAs given in this study (human).

    Source sentences

    Summary
    In between-drug comparisons, all tirzepatide doses were comparable with semaglutide 2.0 mg and superior to semaglutide 1.0 mg and 0.5 mg.
    2 context sentences
    Summary · context
    Secondary outcomes were achievement of HbA1c target of ≤48 mmol/mol (≤6.5%) or <53 mmol/mol (<7.0%), body weight loss of at least 10%, and safety outcomes including gastrointestinal adverse events and severe hypoglycaemia.
    Summary · context
    A total of 28 trials with 23,622 participants (44.2% female) were included.
  5. 05HumanSystematic reviewEfficacy outcome

    In adults with type 2 diabetes, tirzepatide reduced body weight versus placebo, by 5.27 kg at 5 mg up to 9.57 kg at 15 mg.

    In plain wordsIn adults with type 2 diabetes, tirzepatide led to more weight loss than placebo, rising with dose from 5.27 kg to 9.57 kg.

    Outcome
    DecreaseBody weight change versus placebo
    Study

    n: not reported in source

    Comparator
    Placebo
    Analysis
    Primary
    Outcome group
    Body weight · Metabolic and weight
    Studied dose
    5 to 15 mg · subcutaneous · at least 12 weeksAs given in this study (human).

    Measurements

    Weight reduction
    5.27 to 9.57 kg
    tirzepatide 5 to 15 mg vs placebo

    Source sentences

    Summary
    Compared with placebo, tirzepatide was more efficacious than semaglutide for reducing body weight, with reductions ranging from 9.57 kg (tirzepatide 15 mg) to 5.27 kg (tirzepatide 5 mg).
    2 context sentences
    Summary · context
    Secondary outcomes were achievement of HbA1c target of ≤48 mmol/mol (≤6.5%) or <53 mmol/mol (<7.0%), body weight loss of at least 10%, and safety outcomes including gastrointestinal adverse events and severe hypoglycaemia.
    Summary · context
    A total of 28 trials with 23,622 participants (44.2% female) were included.
  6. 06HumanSystematic reviewEfficacy outcome

    In adults with type 2 diabetes, tirzepatide 15, 10 and 5 mg reduced body weight more than semaglutide 2.0, 1.0 and 0.5 mg, respectively.

    In plain wordsIn adults with type 2 diabetes, each tirzepatide dose led to more weight loss than the matching semaglutide dose.

    Outcome
    DecreaseBody weight versus semaglutide
    Study

    n: not reported in source

    Comparator
    Semaglutide
    Analysis
    Primary
    Outcome group
    Body weight · Metabolic and weight
    Studied dose
    5, 10 and 15 mg · subcutaneous · at least 12 weeksAs given in this study (human).

    Source sentences

    Summary
    In between-drug comparisons, tirzepatide 15 mg, 10 mg and 5 mg demonstrated greater efficacy than semaglutide 2.0 mg, 1.0 mg and 0.5 mg, respectively.
    2 context sentences
    Summary · context
    Secondary outcomes were achievement of HbA1c target of ≤48 mmol/mol (≤6.5%) or <53 mmol/mol (<7.0%), body weight loss of at least 10%, and safety outcomes including gastrointestinal adverse events and severe hypoglycaemia.
    Summary · context
    A total of 28 trials with 23,622 participants (44.2% female) were included.
  7. 07HumanSystematic reviewSafety outcome

    In adults with type 2 diabetes, tirzepatide increased the incidence of gastrointestinal adverse events versus placebo.

    In plain wordsIn adults with type 2 diabetes, stomach and gut side effects were more common with tirzepatide than with placebo.

    Outcome
    IncreaseGastrointestinal adverse events versus placebo
    Study

    n = 23,622

    Comparator
    Placebo
    Analysis
    Secondary
    Outcome group
    Gastrointestinal adverse events · Gastrointestinal
    Studied dose
    5, 10 and 15 mg · subcutaneous · at least 12 weeksAs given in this study (human).

    Source sentences

    Summary
    Both drugs increased incidence of gastrointestinal adverse events compared with placebo
    3 context sentences
    Summary · context
    Both drugs, particularly higher doses of tirzepatide, increased gastrointestinal adverse events.
    Summary · context
    Secondary outcomes were achievement of HbA1c target of ≤48 mmol/mol (≤6.5%) or <53 mmol/mol (<7.0%), body weight loss of at least 10%, and safety outcomes including gastrointestinal adverse events and severe hypoglycaemia.
    Summary · context
    A total of 28 trials with 23,622 participants (44.2% female) were included.
  8. 08HumanSystematic reviewSafety outcome

    In adults with type 2 diabetes, tirzepatide did not increase the risk of severe hypoglycaemia.

    In plain wordsIn adults with type 2 diabetes, tirzepatide did not raise the risk of severe low blood sugar compared with placebo.

    Outcome
    No significant changeSevere hypoglycaemia
    Study

    n = 23,622

    Comparator
    Placebo
    Analysis
    Secondary
    Outcome group
    Adverse events · Metabolic and weight
    Studied dose
    5, 10 and 15 mg · subcutaneous · at least 12 weeksAs given in this study (human).

    Source sentences

    Summary
    while neither tirzepatide nor semaglutide increased the risk of serious adverse events or severe hypoglycaemia
    2 context sentences
    Summary · context
    Secondary outcomes were achievement of HbA1c target of ≤48 mmol/mol (≤6.5%) or <53 mmol/mol (<7.0%), body weight loss of at least 10%, and safety outcomes including gastrointestinal adverse events and severe hypoglycaemia.
    Summary · context
    A total of 28 trials with 23,622 participants (44.2% female) were included.
  9. 09HumanSystematic reviewSafety outcome

    In adults with type 2 diabetes, tirzepatide did not increase the risk of serious adverse events.

    In plain wordsIn adults with type 2 diabetes, tirzepatide did not raise the risk of serious side effects compared with placebo.

    Outcome
    No significant changeSerious adverse events
    Study

    n = 23,622

    Comparator
    Placebo
    Outcome group
    Adverse events · Whole body
    Studied dose
    5, 10 and 15 mg · subcutaneous · at least 12 weeksAs given in this study (human).

    Source sentences

    Summary
    while neither tirzepatide nor semaglutide increased the risk of serious adverse events
    2 context sentences
    Summary · context
    Secondary outcomes were achievement of HbA1c target of ≤48 mmol/mol (≤6.5%) or <53 mmol/mol (<7.0%), body weight loss of at least 10%, and safety outcomes including gastrointestinal adverse events and severe hypoglycaemia.
    Summary · context
    A total of 28 trials with 23,622 participants (44.2% female) were included.
  10. 10HumanSystematic reviewEfficacy outcome

    In adults with type 2 diabetes, semaglutide 2.0 mg lowered HbA1c versus placebo (mean difference -17.74 mmol/mol, -1.59%) in a network meta-analysis.

    In plain wordsIn adults with type 2 diabetes, semaglutide 2.0 mg lowered HbA1c more than placebo in a pooled analysis of trials.

    Outcome
    DecreaseHbA1c change versus placebo, semaglutide 2.0 mg
    Study

    n: not reported in source

    Comparator
    Placebo
    Outcome group
    Glycemic control · Metabolic and weight
    Studied dose
    2.0 mg once weekly · subcutaneous · at least 12 weeksAs given in this study (human).

    Measurements

    HbA1c mean difference
    −17.74 mmol/mol
    semaglutide 2.0 mg vs placebo
    HbA1c mean difference
    −1.59%
    semaglutide 2.0 mg vs placebo

    Source sentences

    Summary
    semaglutide 2.0 mg (-17.74 mmol/mol [-1.59%])
    2 context sentences
    Summary · context
    Compared with placebo
    Summary · context
    A total of 28 trials with 23,622 participants (44.2% female) were included.
  11. 11HumanSystematic reviewEfficacy outcome

    In adults with type 2 diabetes, semaglutide 1.0 mg lowered HbA1c versus placebo (mean difference -15.25 mmol/mol, -1.39%) in a network meta-analysis.

    In plain wordsIn adults with type 2 diabetes, semaglutide 1.0 mg lowered HbA1c more than placebo in a pooled analysis of trials.

    Outcome
    DecreaseHbA1c change versus placebo, semaglutide 1.0 mg
    Study

    n: not reported in source

    Comparator
    Placebo
    Outcome group
    Glycemic control · Metabolic and weight
    Studied dose
    1.0 mg once weekly · subcutaneous · at least 12 weeksAs given in this study (human).

    Measurements

    HbA1c mean difference
    −15.25 mmol/mol
    semaglutide 1.0 mg vs placebo
    HbA1c mean difference
    −1.39%
    semaglutide 1.0 mg vs placebo

    Source sentences

    Summary
    semaglutide 1.0 mg (-15.25 mmol/mol [-1.39%])
    2 context sentences
    Summary · context
    Compared with placebo
    Summary · context
    A total of 28 trials with 23,622 participants (44.2% female) were included.
  12. 12HumanSystematic reviewEfficacy outcome

    In adults with type 2 diabetes, semaglutide 0.5 mg lowered HbA1c versus placebo (mean difference -12.00 mmol/mol, -1.09%) in a network meta-analysis.

    In plain wordsIn adults with type 2 diabetes, semaglutide 0.5 mg lowered HbA1c more than placebo in a pooled analysis of trials.

    Outcome
    DecreaseHbA1c change versus placebo, semaglutide 0.5 mg
    Study

    n: not reported in source

    Comparator
    Placebo
    Outcome group
    Glycemic control · Metabolic and weight
    Studied dose
    0.5 mg once weekly · subcutaneous · at least 12 weeksAs given in this study (human).

    Measurements

    HbA1c mean difference
    −12 mmol/mol
    semaglutide 0.5 mg vs placebo
    HbA1c mean difference
    −1.09%
    semaglutide 0.5 mg vs placebo

    Source sentences

    Summary
    semaglutide 0.5 mg (-12.00 mmol/mol [-1.09%])
    2 context sentences
    Summary · context
    Compared with placebo
    Summary · context
    A total of 28 trials with 23,622 participants (44.2% female) were included.
  13. 13HumanSystematic reviewEfficacy outcome

    In adults with type 2 diabetes, semaglutide 2.0 mg lowered HbA1c about as much as all tirzepatide doses, while semaglutide 1.0 mg and 0.5 mg lowered it less.

    In plain wordsIn adults with type 2 diabetes, semaglutide 2.0 mg lowered HbA1c about as much as tirzepatide; the 1.0 and 0.5 mg doses lowered it less.

    Outcome
    MixedHbA1c reduction versus tirzepatide, between-drug comparison
    Study

    n: not reported in source

    Comparator
    Tirzepatide 5, 10 and 15 mg
    Outcome group
    Glycemic control · Metabolic and weight
    Studied dose
    0.5, 1.0 and 2.0 mg once weekly · subcutaneous · at least 12 weeksAs given in this study (human).

    Source sentences

    Summary
    In between-drug comparisons, all tirzepatide doses were comparable with semaglutide 2.0 mg and superior to semaglutide 1.0 mg and 0.5 mg.
    1 context sentence
    Summary · context
    A total of 28 trials with 23,622 participants (44.2% female) were included.
  14. 14HumanSystematic reviewEfficacy outcome

    In adults with type 2 diabetes, semaglutide reduced body weight versus placebo by 2.52 kg (0.5 mg) to 4.97 kg (2.0 mg) in a network meta-analysis.

    In plain wordsIn adults with type 2 diabetes, semaglutide lowered body weight more than placebo, by 2.52 to 4.97 kg depending on dose.

    Outcome
    DecreaseBody weight reduction versus placebo, semaglutide 0.5 to 2.0 mg
    Study

    n: not reported in source

    Comparator
    Placebo
    Outcome group
    Body weight · Metabolic and weight
    Studied dose
    0.5 to 2.0 mg once weekly · subcutaneous · at least 12 weeksAs given in this study (human).

    Measurements

    body weight reduction vs placebo
    2.52 to 4.97 kg
    semaglutide 0.5-2.0 mg

    Source sentences

    Summary
    Semaglutide had a less pronounced effect, with reductions ranging from 4.97 kg (semaglutide 2.0 mg) to 2.52 kg (semaglutide 0.5 mg).
    2 context sentences
    Summary · context
    Compared with placebo
    Summary · context
    A total of 28 trials with 23,622 participants (44.2% female) were included.
  15. 15HumanSystematic reviewEfficacy outcome

    In adults with type 2 diabetes, semaglutide 2.0, 1.0 and 0.5 mg reduced body weight less than tirzepatide 15, 10 and 5 mg, respectively.

    In plain wordsIn adults with type 2 diabetes, semaglutide lowered body weight less than tirzepatide at matched dose steps.

    Outcome
    DecreaseBody weight reduction versus tirzepatide, between-drug comparison
    Study

    n: not reported in source

    Comparator
    Tirzepatide 15, 10 and 5 mg
    Outcome group
    Body weight · Metabolic and weight
    Studied dose
    2.0, 1.0 and 0.5 mg once weekly · subcutaneous · at least 12 weeksAs given in this study (human).

    Source sentences

    Summary
    In between-drug comparisons, tirzepatide 15 mg, 10 mg and 5 mg demonstrated greater efficacy than semaglutide 2.0 mg, 1.0 mg and 0.5 mg, respectively.
    1 context sentence
    Summary · context
    A total of 28 trials with 23,622 participants (44.2% female) were included.
  16. 16HumanSystematic reviewSafety outcome

    In adults with type 2 diabetes, semaglutide increased the incidence of gastrointestinal adverse events compared with placebo.

    In plain wordsIn adults with type 2 diabetes, semaglutide caused more stomach and gut side effects than placebo.

    Outcome
    IncreaseGastrointestinal adverse events versus placebo
    Study

    n: not reported in source

    Comparator
    Placebo
    Outcome group
    Gastrointestinal adverse events · Gastrointestinal
    Studied dose
    0.5, 1.0 or 2.0 mg once weekly · subcutaneous · at least 12 weeksAs given in this study (human).

    Source sentences

    Summary
    Both drugs increased incidence of gastrointestinal adverse events compared with placebo
    1 context sentence
    Summary · context
    A total of 28 trials with 23,622 participants (44.2% female) were included.
  17. 17HumanSystematic reviewSafety outcome

    In adults with type 2 diabetes, semaglutide did not increase the risk of serious adverse events compared with placebo.

    In plain wordsIn adults with type 2 diabetes, semaglutide did not raise the risk of serious side effects compared with placebo.

    Outcome
    No significant changeSerious adverse events versus placebo
    Study

    n: not reported in source

    Comparator
    Placebo
    Outcome group
    Adverse events · Whole body
    Studied dose
    0.5, 1.0 or 2.0 mg once weekly · subcutaneous · at least 12 weeksAs given in this study (human).

    Source sentences

    Summary
    Both drugs increased incidence of gastrointestinal adverse events compared with placebo, while neither tirzepatide nor semaglutide increased the risk of serious adverse events or severe hypoglycaemia.
    1 context sentence
    Summary · context
    A total of 28 trials with 23,622 participants (44.2% female) were included.
  18. 18HumanSystematic reviewSafety outcome

    In adults with type 2 diabetes, semaglutide did not increase the risk of severe hypoglycaemia compared with placebo.

    In plain wordsIn adults with type 2 diabetes, semaglutide did not raise the risk of severe low blood sugar compared with placebo.

    Outcome
    No significant changeSevere hypoglycaemia versus placebo
    Study

    n: not reported in source

    Comparator
    Placebo
    Outcome group
    Adverse events · Metabolic and weight
    Studied dose
    0.5, 1.0 or 2.0 mg once weekly · subcutaneous · at least 12 weeksAs given in this study (human).

    Source sentences

    Summary
    Both drugs increased incidence of gastrointestinal adverse events compared with placebo, while neither tirzepatide nor semaglutide increased the risk of serious adverse events or severe hypoglycaemia.
    1 context sentence
    Summary · context
    A total of 28 trials with 23,622 participants (44.2% female) were included.

AI wrote and checked these results. AI can make mistakes, so check important results against the source.

Version history

PepBank keeps every version of the data on this study. Status changes from Retraction Watch, Europe PMC and Crossref are listed with their source.

  1. Versions 3 to 38Current

    28 Oct 2026, 02:04 UTC

    The same notice was added 36 times, first on 9 Oct 2026, 19:08 UTC. The status did not change between them.

    Study results updated

  2. Version 2

    9 Oct 2026, 03:07 UTC

    Study data updated · source update from Europe PMC

  3. Version 1

    9 Oct 2026, 03:06 UTC

    First added · source update from Europe PMC

Subjects

Terms as the source lists them.

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