All three doses of tirzepatide achieved superior A1C and weight reductions compared to semaglutide in data simultaneously presented at the American Diabetes Association’s® 81st Scientific Sessions®
Tirzepatide led to superior A1C and body weight reductions from baseline compared to injectable semaglutide 1 mg in 40-week results from Eli Lilly and Company’s (NYSE: LLY) SURPASS-2 clinical trial, which were simultaneously published today in The New England Journal of Medicine (NEJM)1 and presented in a late breaking poster presentation during the American Diabetes Association’s® (ADA) 81st Scientific Sessions®2. These results, which will also be featured during an ADA-sponsored symposium on Tuesday, June 29, showed that all three tirzepatide doses achieved greater A1C and weight reductions compared to semaglutide.
Additionally, a prespecified exploratory composite endpoint comprised of participants who achieved an A1C level less than or equal to 6.5 percent and weight loss of 10 percent or greater, while not experiencing hypoglycemia less than 54 mg/dL or severe hypoglycemia, was evaluated. Across the three doses of tirzepatide, 32 percent (5 mg), 51 percent (10 mg) and 60 percent (15 mg) of participants achieved this composite endpoint compared to 22 percent of participants taking semaglutide 1 mg.1,2
The overall safety profile of tirzepatide was similar to the well-established glucagon-like peptide-1 (GLP-1) receptor agonist class. Across all treatment arms, the most commonly reported adverse events were gastrointestinal-related.
“Tirzepatide delivered superior blood glucose and weight reductions compared to semaglutide and, importantly, many people on tirzepatide achieved significant A1C reductions without experiencing hypoglycemia less than 54 mg/dL,” said Juan Pablo Frías, M.D., Medical Director, National Research Institute and Principal Investigator of SURPASS-2. “These findings are significant as we continue to evaluate the comprehensive efficacy and safety profile of this potential new treatment option for people with type 2 diabetes.”
Tirzepatide is a novel investigational once-weekly dual glucose-dependent insulinotropic polypeptide (GIP) and GLP-1 receptor agonist that integrates the actions of both incretins into a single molecule, representing a new class of medicines being studied for the treatment of type 2 diabetes. Injectable semaglutide 1 mg is a GLP-1 receptor agonist and the highest dose of injectable semaglutide FDA-approved for the treatment of type 2 diabetes.
SURPASS-2 was a 40-week, randomized, open-label trial comparing the efficacy and safety of tirzepatide to semaglutide as an add-on to metformin in adults with type 2 diabetes. The study randomized 1,879 participants, who had a mean duration of diabetes of 8.6 years, a baseline A1C of 8.28 percent and a baseline weight of 93.7 kg.
For both estimandsi, all three doses of tirzepatide demonstrated superior A1C and body weight reductions compared to semaglutide 1 mg. Specifically, the efficacy estimandii results showed:
- A1C reduction: -2.09% (5 mg), -2.37% (10 mg), -2.46% (15 mg), -1.86% (semaglutide)
- Weight reduction: -7.8 kg (-8.5%, 5 mg), -10.3 kg (-11.0%, 10 mg), -12.4 kg (-13.1%, 15 mg), -6.2 kg (-6.7%, semaglutide)
- Percent of participants achieving A1C <7%: 85% (5 mg), 89% (10 mg), 92% (15 mg), 81% (semaglutide)
- Percent of participants achieving A1C <5.7%: 29% (5 mg, not controlled for type 1 error), 45% (10 mg), 51% (15 mg), 20% (semaglutide)
For the treatment-regimen estimandiii, all three doses of tirzepatide delivered superior A1C and body weight reductions compared to semaglutide. Greater percentages of participants achieved an A1C of less than 7 percent across all three doses compared to semaglutide, with statistical significance met for 10 mg and 15 mg but not for 5 mg. Specifically:
- A1C reduction: -2.01% (5 mg), -2.24% (10 mg), -2.30% (15 mg), -1.86% (semaglutide)
- Weight reduction: -7.6 kg (5 mg), -9.3 kg (10 mg), -11.2 kg (15 mg), -5.7 kg (semaglutide)
- Percent of participants achieving A1C <7%: 82% (5 mg), 86% (10 mg), 86% (15 mg), 79% (semaglutide)
- Percent of participants achieving A1C <5.7%: 27% (5 mg), 40% (10 mg), 46% (15 mg), 19% (semaglutide)
Hypoglycemia less than 54 mg/dL was reported in 0.6 percent (5 mg), 0.2 percent (10 mg) and 1.7 percent (15 mg) of participants in the tirzepatide arms and in 0.4 percent of participants in the semaglutide arm.
In an additional exploratory endpoint, all three doses of tirzepatide led to favorable changes from baseline in fasting lipids. Specifically, at the highest dose of tirzepatide (15 mg): triglycerides were reduced by 24.8 percent, very low-density lipoprotein (VLDL) cholesterol was reduced by 23.7 percent, and high-density lipoprotein (HDL) cholesterol was increased by 7.1 percent.2
The most commonly reported adverse events across all treatment arms were gastrointestinal-related and mostly mild-to-moderate, including nausea (17.4 percent [5 mg], 19.2 percent [10 mg], 22.1 percent [15 mg], 17.9 percent [semaglutide]), diarrhea (13.2 percent [5 mg], 16.4 percent [10 mg], 13.8 percent [15 mg], 11.5 percent [semaglutide]) and vomiting (5.7 percent [5 mg], 8.5 percent [10 mg], 9.8 percent [15 mg], 8.3 percent [semaglutide]). Treatment discontinuation rates due to adverse events were 5.1 percent (5 mg), 7.7 percent (10 mg), 7.9 percent (15 mg) and 3.8 percent (semaglutide).
“Tirzepatide showed superior results in glucose control and weight reduction in this study, which are both important measures of health for people living with type 2 diabetes,” said Mike Mason, president, Lilly Diabetes. “As a leader in diabetes care, Lilly is committed to bringing innovative solutions to people living with type 2 diabetes, including this dual GIP and GLP-1 receptor agonist, which leverages the effects of both incretins.”
SURPASS-2 is the second of five global registration studies for tirzepatide in type 2 diabetes, all of which have been completed. Lilly intends to submit the full registration package to regulatory authorities by the end of 2021.
Tirzepatide is a once-weekly dual glucose-dependent insulinotropic polypeptide (GIP) and glucagon-like peptide-1 (GLP-1) receptor agonist that integrates the actions of both incretins into a single novel molecule. GIP is a hormone that may complement the effects of GLP-1. In preclinical models, GIP has been shown to decrease food intake and increase energy expenditure therefore resulting in weight reductions, and when combined with a GLP-1 receptor agonist, may result in greater effects on glucose and body weight. Tirzepatide is in phase 3 development for blood glucose management in adults with type 2 diabetes and for chronic weight management. It is also being studied as a potential treatment for non-alcoholic steatohepatitis (NASH) and heart failure with preserved ejection fraction (HFpEF).
1. Frias, J.P, et. al. (2021). Tirzepatide vs. Semaglutide Once Weekly for Patients with Type 2 Diabetes. The New England Journal of Medicine, www.nejm.org/doi/full/10.1056/NEJMoa2107519.
2 Frias, J.P. Efficacy and Safety of Tirzepatide vs. Semaglutide Once Weekly as Add-On Therapy to Metformin in Patients with Type 2 Diabetes. Abstract 84-LB. Presented virtually at the American Diabetes Association’s 81st Scientific Sessions; June 25-29.
3 Centers for Disease Control and Prevention. National Diabetes Statistics Report, 2020. Atlanta, GA: Centers for Disease Control and Prevention, U.S. Dept. of Health and Human Services; 2020.
4 International Diabetes Federation. IDF Diabetes Atlas, 9th edn. Brussels, Belgium: International Diabetes Federation, 2019. Available at: http://diabetesatlas.org.
i Treatment differences for two estimands – efficacy and treatment-regimen – were evaluated for three tirzepatide doses (5 mg, 10 mg and 15 mg) compared to semaglutide 1 mg.
ii Efficacy estimand represents efficacy prior to discontinuation of study drug or initiating rescue therapy for persistent severe hyperglycemia.
iii Treatment-regimen estimand represents the efficacy irrespective of adherence to the investigational medicine or introduction of rescue therapy for persistent severe hyperglycemia.
SOURCE Eli Lilly & Company