Survodutide
InvestigationalA dual GLP-1/glucagon receptor agonist developed by Boehringer Ingelheim/Zealand Pharma, currently in Phase 3 trials for obesity and MASH. Phase 2 data show up to 14.9% weight loss and up to 62% MASH improvement, with unique liver-targeting benefits from glucagon receptor agonism.
BI 456906 · BI-456906 · ZP6590
16 human studies
- Preclinical
- 20%
- Clinical
- 80%
Based on 20 cited sources
clinically demonstrated · moderate confidence
Demonstrated effect magnitude — not a recommendation or safety claim.
Research Depth 77: ≥2 independent Phase 2 RCTs across obesity (le Roux 38330987, N=387), MASH (Sanyal 38847460, N=293) and T2D (Blüher 38095657, N=413) — 1A 30 (≥2 independent RCTs, no SR/MA in this evidence base), 1B 15 (low-RoB double-blind placebo-controlled NEJM/Lancet trials, no high-confidence SR), 1C 11 (total human N ~1,000), 1D 14 (population/route/ outcome direct), 1E 7 (multi-study preclinical program: Zimmermann 36356832, Monfeuga 38065435, Pocai 19602537). Mechanism 96: 2A 40 (GLP-1R+GCGR named, binding+functional+class antagonist/knockout confirmation; dual agonism confirmed for BI 456906), 2B 28 (full target→effect pathway), 2C 18 (clinical + preclinical in-vivo dose-response), 2D 10 (in-vivo mammalian + human). Plausibility 91: 3A 36 (mechanism→surrogate→clinical chain supported; CV outcomes pending), 3B 24 (coherent with metabolic biology; glucagon glycemic tension resolved by net effect), 3C 18 (multiple same-class agents — semaglutide/tirzepatide/retatrutide/mazdutide — show the effect), 3D 13 (tightly scoped metabolic/hepatic claims). Global Coverage 54: 4A 20 (multi- country/multi-site but single sponsor — Boehringer Ingelheim), 4B 16 (European-led + US sites), 4C 13 (~20 studies), 4D 5 (investigational, Phase 3 registered, not yet approved). Community Experience 24: niche enthusiast discussion only, no recorded anecdotal reports, short investigational track record (5A 6, 5B 5, 5C 5, 5D 8). Effectiveness basis clinical (moderate): 14.9% weight loss vs 2.8% placebo and 62% MASH resolution vs 14% far exceed the ~5% weight MCID (E1 27, E2 23), mix of hard + surrogate outcomes (E3 13), superior to placebo on clinical outcomes with no head-to-head superiority trial yet (E4 15). Scored on Phase 2 evidence base; Phase 3 SYNCHRONIZE results were not yet published at lastUpdated.
Survodutide is a dual GLP-1/glucagon receptor agonist with Phase 2 clinical trial evidence supporting its mechanisms in humans.
How It Works (Simplified)
Survodutide acts as a “dual signal” metabolic regulator through complementary pathways:
GLP-1 receptor activation in the brain promotes satiety, reducing food intake and cravings through hypothalamic signaling.
Glucagon receptor activation directly targets the liver (which lacks GLP-1 receptors), promoting hepatic lipid oxidation and reducing fatty liver.
GLP-1 enhances insulin secretion while glucagon typically raises glucose - the dual action maintains glycemic control with net improvement.
Glucagon receptor activation in brown adipose tissue may increase energy expenditure, adding caloric burn beyond appetite reduction.
Key Research: Sanyal AJ et al. (NEJM, 2024) reported MASH improvement without worsening of fibrosis in up to 62% of survodutide-treated participants (4.8mg dose) vs 14% on placebo in a 48-week Phase 2 trial. PMID:38847460
Important Limitations
- Phase 3 trials ongoing; not yet FDA approved for any indication
- Long-term safety beyond 48 weeks not established
- No head-to-head trials vs semaglutide or tirzepatide
- Cardiovascular outcomes unknown (CVOT results expected 2029+)
- Cross-trial comparisons to other agents are inherently unreliable
| NCT ID | Title | Peptide | Phase | Status | Completion |
|---|---|---|---|---|---|
| NCT05486065 | ACHIEVE: A Study of Survodutide in Adults With MASH and Fibrosis Metabolic dysfunction-associated steatohepatitis, Liver fibrosis | Survodutide | Phase 3 | Active | Dec 2026 |
| NCT05642455 | SYNCHRONIZE-1: Survodutide for Weight Management in Adults With Obesity Obesity, Overweight | Survodutide | Phase 3 | Active | Mar 2026 |
| NCT05642468 | SYNCHRONIZE-2: Survodutide for Weight Management in Adults With Obesity and Type 2 Diabetes Obesity, Type 2 diabetes mellitus | Survodutide | Phase 3 | Active | Jun 2026 |
| NCT05607667 | SYNCHRONIZE-CVOT: Cardiovascular Outcomes With Survodutide Obesity, Cardiovascular disease | Survodutide | Phase 3 | Recruiting | Dec 2029 |
| NCT05179576 | Phase 2 Study of BI 456906 in Adults With Obesity Obesity | Survodutide | Phase 2 | Completed | Aug 2023 |
| NCT04771273 | Phase 2 Study of BI 456906 in NASH/MASH Non-alcoholic Steatohepatitis (NASH) | Survodutide | Phase 2 | Completed | Nov 2023 |
| NCT04153929 | Phase 2 Study of BI 456906 in Type 2 Diabetes Type 2 diabetes mellitus | Survodutide | Phase 2 | Completed | Jun 2021 |
| NCT04043793 | Phase 1 First-in-Human Study of BI 456906 Healthy volunteers, Type 2 diabetes mellitus | Survodutide | Phase 1 | Completed | Dec 2020 |
| NCT07413913 | A Study in Healthy People or Otherwise Healthy With Overweight or Obesity to Compare 2 Formulations of Survodutide Given in Different Ways, Either as a Pre-filled Syringe or a Pen-like Injector Healthy, Obesity | Survodutide | Phase 1 | Active | May 2026 |
| NCT07206290 | Albuminuria Reduction Study With Survodutide Treatment in Kidney Disease Chronic Kidney Disease | Survodutide | Phase 2 | Not yet recruiting | Nov 2027 |
| NCT07407348 | A Study in People With Overweight or Obesity to Compare How 2 Different Formulations of Survodutide Are Taken up by the Body Healthy, Obesity +1 more | Survodutide | Phase 1 | Recruiting | Jan 2027 |
| NCT07221591 | A Study in Healthy People to Compare How 2 Different Formulations of Survodutide Are Taken up by the Body Healthy | Survodutide | Phase 1 | Active | Aug 2026 |
| NCT07071974 | A Study in Healthy People to Compare How 2 Different Formulations of Survodutide Are Taken up in the Body Healthy | Survodutide | Phase 1 | Completed | Oct 2025 |
| NCT06745284 | A Study to Test Whether Survodutide Improves How the Body Uses Energy and Breaks Down Fat in People With Obesity Obesity | Survodutide | Phase 1 | Active | Jan 2027 |
| NCT06772532 | A Study in Healthy People to Compare How 3 Different Formulations of Survodutide Are Taken up in the Body Healthy | Survodutide | Phase 1 | Completed | May 2025 |
| NCT06632457 | LIVERAGE™ - Cirrhosis: A Study to Test Whether Survodutide Helps People With a Liver Disease Called NASH/MASH Who Have Cirrhosis Metabolic Dysfunction Associated Steatohepatitis | Survodutide | Phase 3 | Recruiting | Jun 2029 |
| NCT05202353 | A Study in People With Obesity to Test the Effects of BI 456906 Compared With Semaglutide on Glucagon Receptor Activity in the Liver Obesity | Survodutide | Phase 1 | Recruiting | Dec 2026 |
| NCT06564441 | A Study to Test Whether BI 456906 (Survodutide) Influences the Amount of Bupropion, Caffeine and Midazolam in the Blood in People With Overweight or Obesity Overweight, Obesity | Survodutide | Phase 1 | Completed | Dec 2025 |
| NCT06632444 | LIVERAGE™: A Study to Test Whether Survodutide Helps People With a Liver Disease Called NASH/MASH Who Have Moderate or Advanced Liver Fibrosis Metabolic Dysfunction Associated Steatohepatitis (MASH), Liver Fibrosis | Survodutide | Phase 3 | Recruiting | Dec 2031 |
| NCT06492135 | A Study in Chinese People With Overweight or Obesity to Test How Different Doses of Survodutide Are Taken up in the Body Overweight, Obesity | Survodutide | Phase 1 | Completed | Apr 2025 |
| NCT06352411 | A Study to Test How BI 456906 is Taken up in the Blood of People With and Without Kidney Problems Healthy, Renal Impairment | Survodutide | Phase 1 | Completed | Sep 2025 |
| NCT06309992 | A Study to Test Whether Survodutide Helps People Living With Obesity or Overweight and With a Confirmed or Presumed Liver Disease Called Non-alcoholic Steatohepatitis (NASH) to Reduce Liver Fat and to Lose Weight (SYNCHRONIZE-MASLD) Obesity, Non-Alcoholic SteatoHepatitis (NASH) | Survodutide | Phase 3 | Completed | Oct 2025 |
| NCT06200467 | A Study to Test Whether Multiple Doses of BI 456906 Have an Effect on Cardiac Safety in People With Overweight or Obesity Overweight, Obesity | Survodutide | Phase 1 | Completed | Oct 2025 |
| NCT06214741 | A Study to Test Whether Survodutide (BI 456906) Helps Chinese People Living With Overweight or Obesity to Lose Weight Obesity, Overweight | Survodutide | Phase 3 | Completed | Jul 2025 |
| NCT06176365 | A Study to Test Whether Survodutide Helps Japanese People Living With Obesity Disease Obesity | Survodutide | Phase 3 | Completed | Dec 2025 |
| NCT05896384 | A Study in Women With Overweight or Obesity to Test Whether Different Doses of BI 456906 Influence the Amount of a Contraceptive in the Blood Healthy | Survodutide | Phase 1 | Completed | Feb 2025 |
| NCT06066528 | A Study to Test Whether Survodutide (BI 456906) Helps People Living With Overweight or Obesity Who Also Have Diabetes to Lose Weight Obesity, Diabetes Mellitus, Type 2 | Survodutide | Phase 3 | Completed | Dec 2025 |
| NCT06066515 | A Study to Test Whether Survodutide (BI 456906) Helps People Living With Overweight or Obesity Who do Not Have Diabetes to Lose Weight Obesity | Survodutide | Phase 3 | Completed | Dec 2025 |
| NCT06077864 | A Study to Test the Effect of Survodutide (BI 456906) on Cardiovascular Safety in People With Overweight or Obesity (SYNCHRONIZE™ - CVOT) Obesity | Survodutide | Phase 3 | Active | May 2026 |
| NCT05296733 | A Study to (1) Compare How BI 456906 is Taken up in the Body of Healthy People and People With Liver Problems and (2) Find Out How People With Overweight and Obesity, With and Without Liver Problems, Tolerate Different Doses of BI 456906 Healthy, Liver Diseases +1 more | Survodutide | Phase 1 | Completed | Dec 2023 |
| NCT04667377 | A Study to Test Whether Different Doses of BI 456906 Help People With Overweight or Obesity to Lose Weight Obesity | Survodutide | Phase 2 | Completed | Sep 2022 |
ACHIEVE: A Study of Survodutide in Adults With MASH and Fibrosis
SYNCHRONIZE-1: Survodutide for Weight Management in Adults With Obesity
SYNCHRONIZE-2: Survodutide for Weight Management in Adults With Obesity and Type 2 Diabetes
SYNCHRONIZE-CVOT: Cardiovascular Outcomes With Survodutide
Phase 2 Study of BI 456906 in Adults With Obesity
Phase 2 Study of BI 456906 in Type 2 Diabetes
A Study in Healthy People or Otherwise Healthy With Overweight or Obesity to Compare 2 Formulations of Survodutide Given in Different Ways, Either as a Pre-filled Syringe or a Pen-like Injector
Albuminuria Reduction Study With Survodutide Treatment in Kidney Disease
A Study in People With Overweight or Obesity to Compare How 2 Different Formulations of Survodutide Are Taken up by the Body
A Study in Healthy People to Compare How 2 Different Formulations of Survodutide Are Taken up by the Body
A Study in Healthy People to Compare How 2 Different Formulations of Survodutide Are Taken up in the Body
A Study to Test Whether Survodutide Improves How the Body Uses Energy and Breaks Down Fat in People With Obesity
A Study in Healthy People to Compare How 3 Different Formulations of Survodutide Are Taken up in the Body
LIVERAGE™ - Cirrhosis: A Study to Test Whether Survodutide Helps People With a Liver Disease Called NASH/MASH Who Have Cirrhosis
A Study in People With Obesity to Test the Effects of BI 456906 Compared With Semaglutide on Glucagon Receptor Activity in the Liver
A Study to Test Whether BI 456906 (Survodutide) Influences the Amount of Bupropion, Caffeine and Midazolam in the Blood in People With Overweight or Obesity
LIVERAGE™: A Study to Test Whether Survodutide Helps People With a Liver Disease Called NASH/MASH Who Have Moderate or Advanced Liver Fibrosis
A Study in Chinese People With Overweight or Obesity to Test How Different Doses of Survodutide Are Taken up in the Body
A Study to Test How BI 456906 is Taken up in the Blood of People With and Without Kidney Problems
A Study to Test Whether Survodutide Helps People Living With Obesity or Overweight and With a Confirmed or Presumed Liver Disease Called Non-alcoholic Steatohepatitis (NASH) to Reduce Liver Fat and to Lose Weight (SYNCHRONIZE-MASLD)
A Study to Test Whether Multiple Doses of BI 456906 Have an Effect on Cardiac Safety in People With Overweight or Obesity
A Study to Test Whether Survodutide (BI 456906) Helps Chinese People Living With Overweight or Obesity to Lose Weight
A Study to Test Whether Survodutide Helps Japanese People Living With Obesity Disease
A Study in Women With Overweight or Obesity to Test Whether Different Doses of BI 456906 Influence the Amount of a Contraceptive in the Blood
A Study to Test Whether Survodutide (BI 456906) Helps People Living With Overweight or Obesity Who Also Have Diabetes to Lose Weight
A Study to Test Whether Survodutide (BI 456906) Helps People Living With Overweight or Obesity Who do Not Have Diabetes to Lose Weight
A Study to Test the Effect of Survodutide (BI 456906) on Cardiovascular Safety in People With Overweight or Obesity (SYNCHRONIZE™ - CVOT)
A Study to (1) Compare How BI 456906 is Taken up in the Body of Healthy People and People With Liver Problems and (2) Find Out How People With Overweight and Obesity, With and Without Liver Problems, Tolerate Different Doses of BI 456906
A Study to Test Whether Different Doses of BI 456906 Help People With Overweight or Obesity to Lose Weight
Dose escalation phase. Common GI side effects (nausea, reduced appetite) typically emerge. Early weight loss primarily from reduced caloric intake via GLP-1 pathway.
PMID:38330987Continued dose escalation toward target dose. Weight loss accelerates. GI tolerability typically improves. Early metabolic improvements in glucose and liver enzymes.
PMID:38095657Target dose achieved. Steady-state drug levels (~4-5 weeks after stable dosing). Significant weight loss observable. Liver fat reduction becomes measurable.
PMID:38847460Continued weight loss with trajectory not yet plateaued at 46 weeks. In MASH patients, histological improvements (resolution, fibrosis) documented at 48 weeks.
PMID:38330987Research-based observations
This timeline reflects observations from published clinical and preclinical studies. Individual responses may vary significantly. This is not a guarantee of effects or a dosing schedule. Consult qualified healthcare providers for personalized guidance.
Good Signs (6 indicators)
Warning Signs (5 indicators)
Bad Signs (6 indicators)
For Research Evaluation Only
These quality indicators are general guidelines based on typical peptide characteristics. Professional laboratory testing (HPLC, mass spectrometry) provides definitive quality verification. This checklist is for initial visual evaluation only.
TB-500
CompatibleNon-overlapping mechanisms. TB-500 focuses on tissue repair while survodutide targets metabolic pathways. No known contraindications.
GHK-Cu
CompatibleDifferent mechanisms of action. GHK-Cu targets copper-mediated signaling while survodutide affects GLP-1/glucagon pathways. No interaction concerns.
BPC-157
CautionBPC-157 affects GI function and survodutide slows gastric emptying. Unclear if effects interact; monitor GI symptoms if combined.
Semaglutide
AvoidBoth are GLP-1 receptor agonists. Combining would result in overlapping mechanisms with increased risk of severe GI adverse events and no established benefit. Contraindicated.
Tirzepatide
AvoidBoth target GLP-1 receptor pathway. Combination would duplicate mechanisms and significantly increase adverse event risk without demonstrated benefit.
Retatrutide
AvoidRetatrutide is a triple agonist (GLP-1/GIP/glucagon) that fully overlaps with survodutide's dual mechanism. Combining would be redundant with compounded risks.
Research Note: Interaction data is based on published literature, mechanistic understanding, and theoretical considerations. Most peptide combinations lack direct clinical study. This information is for educational purposes only and does not constitute medical advice. Always consult qualified healthcare providers.
Key Studies Cited
Full reference list available on request. All citations link to PubMed for verification.
This dossier synthesizes available evidence from peer-reviewed literature, regulatory documents, and clinical trial registries. Evidence strength ratings follow a modified GRADE approach.
For complete methodology details, see our Methodology page.
Important Disclaimer
This dossier is for educational purposes only and does not constitute medical advice. Always consult a qualified healthcare provider before making health decisions.
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