Survodutide

3.6 mg target		12.2%
6.0 mg target		13%
Placebo		5.4%

Average body-weight reduction at 76 weeks. SYNCHRONIZE-1 included 725 treated adults. These are the main treatment-regimen estimates, which account for interruptions and stopping.¹³³⁷

The latest diabetes results

SYNCHRONIZE-2 treated 752 adults with type 2 diabetes. Average weight loss was 8.2% and 9.8% with survodutide, compared with 3.9% on placebo. It was published October 1, 2026.¹³³⁸

What changed in the liver?

62% versus 14%

At the 4.8 mg assigned dose, MASH improved without worsening fibrosis in 62% of participants, compared with 14% on placebo after 48 weeks. Other assigned doses produced response rates of 47% and 43%.¹³³⁹

Inflammation and fibrosis

The main biopsy outcome measured improvement in disease activity. Fibrosis improved by at least one stage in 34% to 36% of the active groups, versus 22% with placebo. Secondary and post hoc results need their own endpoint labels.¹³³⁹

The newer imaging trial

In phase 3 MASLD research, 68.5% reached at least a 30% reduction in liver fat, versus 28.6% with placebo. FibroScan stiffness improved, while MRI elastography showed no clear difference. The trial did not repeat biopsies.¹³⁴⁰

Tolerability and comparison

About 1 in 4

In SYNCHRONIZE-1, 23.7% and 24.8% of the survodutide groups stopped treatment because of adverse events, compared with 5.4% on placebo. Gastrointestinal symptoms accounted for most of these withdrawals.¹³³⁷

Read the analysis behind the headline

The 16.6% and 13.1% weight-loss figures model continued adherence in the trials without and with diabetes. The corresponding main treatment-regimen results were 13.0% and 9.8%.^1337,1338

Comparison with semaglutide

An earlier 16-week diabetes trial used open-label semaglutide up to 1.0 mg weekly as a reference. It was a glucose-lowering and dose-finding study. The phase 3 weight trials used placebo.^1341,1337

Common questions

01 How much weight did people lose without diabetes?

In SYNCHRONIZE-1, 725 adults received survodutide or placebo for 76 weeks. Average weight loss was 12.2% with the 3.6 mg target and 13.0% with the 6.0 mg target, compared with 5.4% with placebo. This main analysis included what happened after treatment interruptions and discontinuation.¹³³⁷

02 What changed in the latest diabetes trial?

SYNCHRONIZE-2, published October 1, 2026, treated 752 adults with obesity or overweight and type 2 diabetes. Average weight loss at 76 weeks was 8.2% and 9.8% in the two survodutide groups, compared with 3.9% with placebo.¹³³⁸

03 Why do I see both 9.8% and 13.1% for the same trial?

The 9.8% result includes treatment interruptions, stopping and prohibited weight-loss medication use. The 13.1% estimate models what would happen if everyone followed the assigned treatment. The corresponding placebo results were 3.9% and 3.1%.¹³³⁸

04 Did everyone lose a lot of weight?

Responses varied. In the 6.0 mg group without diabetes, 28.5% reached at least 20% weight loss, compared with 6.6% on placebo. In the diabetes trial, those figures were 11.2% and 1.6%. Both are estimates from the main treatment-regimen analyses.^1337,1338

05 How many people stopped because of side effects?

In the phase 3 trial without diabetes, adverse events led 23.7% and 24.8% of the two survodutide groups to stop treatment, compared with 5.4% on placebo. In the diabetes trial, the figures were 26.4%, 25.9% and 8.8%.^1337,1338

06 Were stomach problems common?

Yes. In SYNCHRONIZE-1, nausea affected 61.0% and 64.9% of participants in the two survodutide groups, compared with 17.4% on placebo. Vomiting affected 40.7%, 44.6% and 6.2%. Most gastrointestinal events were mild or moderate and occurred during dose escalation.¹³³⁷

07 Does it preserve muscle while losing fat?

The MRI subgroup lost lean volume as well as fat. Among 25 participants assigned 6.0 mg who had usable scans and stayed on treatment, lean volume fell 9.8%, while total fat volume fell 27.8%. The study did not measure whether strength was preserved.¹³³⁷

08 What does the reported 11.3% lean-loss ratio mean?

It is the slope of a statistical relationship between changes in lean mass and total tissue mass in the MRI subgroup. It is easy to misread as a simple percentage of total weight lost. The paper separately reports a 9.8% fall in lean volume in the 6.0 mg group.¹³³⁷

09 Did it improve fatty liver?

Yes. In a 216-person phase 3 trial of obesity and at-risk MASLD, 68.5% of the survodutide group reached at least a 30% reduction in liver fat, compared with 28.6% on placebo. Liver fat was measured by MRI after 48 weeks.¹³⁴⁰

10 Did the liver trial show that scar tissue reversed?

Its results differed by test. A FibroScan stiffness measure improved, while MRI elastography did not clearly differ from placebo. Most participants had early disease defined by noninvasive tests; the trial did not repeat liver biopsies to establish fibrosis regression.¹³⁴⁰

11 What did the biopsy study find?

The 48-week phase 2 study treated 293 adults with MASH and fibrosis. MASH improved without worsening fibrosis in 47%, 62% and 43% of the three survodutide groups, compared with 14% on placebo. Improvement meant a specified reduction in biopsy activity scores.¹³³⁹

12 Is MASH improvement the same as MASH resolution?

No. Improvement requires a reduction in the biopsy activity score; resolution uses stricter criteria for inflammation and liver-cell injury. The phase 2 paper reports both, using separate endpoints. Its main result was improvement without worsening fibrosis.¹³³⁹

13 Where did the 83% liver-response headline come from?

It came from people with paired biopsies, regrouped under the trial’s actual-treatment rules. Early discontinuers could be assigned to the next target above their last tolerated dose. The main assigned-dose analysis counted missing biopsies as nonresponse.¹³³⁹

14 Has survodutide actually been compared with semaglutide?

Yes, in a 16-week diabetes study with an open-label semaglutide reference group. The highest survodutide regimen produced an estimated 8.7% weight reduction versus 5.3% with semaglutide. Semaglutide was studied at up to 1.0 mg weekly; the trial was designed around glucose lowering and dose finding.¹³⁴¹

15 Does that prove it beats Wegovy or tirzepatide?

A fair answer needs a trial using comparable doses, follow-up and participants. The earlier semaglutide comparison used a 1.0 mg weekly reference dose for 16 weeks. The newer phase 3 weight-loss trials compared survodutide with placebo.^{1341,1337,1338}

16 Does the glucagon effect make blood sugar worse?

Average glucose control improved in the diabetes trial. From an average HbA1c of 7.4%, the two survodutide groups fell by 0.9 and 0.8 percentage points, compared with 0.2 on placebo in the main analysis.¹³³⁸

17 Can blood sugar go too low?

It occurred in 8.0% and 9.2% of the survodutide groups in SYNCHRONIZE-2, compared with 4.0% on placebo. One participant had severe hypoglycemia requiring help; that person was also taking a sulfonylurea.¹³³⁸

18 What happened to heart rate?

Mean heart rate rose by 3.2 to 3.5 beats per minute in the phase 3 trial without diabetes and by 2.7 to 2.9 in the diabetes trial. Placebo groups had small decreases. Cardiovascular event outcomes require a larger, longer trial.^1337,1338

19 Were gallbladder problems reported?

Yes. In SYNCHRONIZE-1, gallstones occurred in 1.2% and 2.1% of the survodutide groups, compared with 0.4% on placebo. Gallbladder inflammation occurred in 0.8%, 0.4% and 0%. These were small event counts.¹³³⁷

20 Did people stay on treatment for the full trial?

About two-thirds did. At week 76, 64.7% and 65.7% of the survodutide groups without diabetes were still receiving treatment. Trial follow-up was more complete because people could stop the drug while continuing study visits.¹³³⁷

21 Did the liver paper have a correction?

Yes. The August 2026 correction fixed investigator details, a placebo denominator and the heart-rate measurement week. The corrected text uses 28 of 70 placebo participants for treatment discontinuation and week 52 for heart rate. The liver-fat results were not changed by that notice.^1342,1340

22 Who paid for the main trials?

Boehringer Ingelheim funded the trials and took part in their design and analysis. Several authors were company employees, and the company funded writing support. The papers disclose those relationships.^{1337,1338,1339,1340,1341}

23 Do women and men respond differently?

In the earlier obesity trial, women assigned 4.8 mg lost an average 17.0% of body weight and men 11.9%. Stomach-related side effects were also more common in women. These small subgroup comparisons offer a clue; they cannot predict an individual response.¹³⁴³

24 Does it repair insulin-producing cells?

Researchers measured blood-based estimates of insulin sensitivity and beta-cell function. Some improved in participants with diabetes, while the beta-cell measure did not clearly change in those without diabetes. Whether any improvement lasts after treatment stops remains unanswered.¹³⁴⁴

25 Has it been studied in people with cirrhosis?

Yes, in small early-phase studies. Repeated dosing included Child-Pugh A and B cirrhosis. People with Child-Pugh C received only a single dose, so that study leaves repeated treatment in advanced cirrhosis unresolved.¹³⁴⁵

26 Does it slow stomach emptying?

An early study in 36 Japanese men found reduced paracetamol absorption during initial treatment at higher doses, consistent with slower stomach emptying. The effect appeared transient. The study did not establish how every other oral medicine would be affected.¹³⁴⁶

27 Are the liver effects just from weight loss?

A reanalysis linked weight loss to much of the improvement in MASH and to a smaller part of the fibrosis response. The estimates came from a statistical model of selected participants with repeat biopsies. A trial designed to separate the receptor effects would answer the mechanism question more directly.¹³⁴⁷

28 Why do older articles say 18.7% weight loss?

That figure groups participants by the dose they actually reached and uses on-treatment observations. The earlier trial’s main planned-dose result was 14.9% at 4.8 mg, compared with 2.8% on placebo. The newer phase 3 studies use their own populations and analyses.^1348,1343

29 Did the early trials flag heart or blood-vessel effects?

Yes. In one 80-person early-phase study, six participants stopped because of cardiac or vascular adverse events. Later trials give more detail on heart rate, blood pressure and tolerability, but they do not resolve long-term cardiovascular outcomes.^1349,1337

30 Has laboratory testing established what is in online survodutide vials?

Some testing exists. A 2026 preprint examined voluntarily submitted samples and found variable amounts and purity, including survodutide. Its accessible text omitted the number of survodutide samples, leaving no denominator for a market-wide failure rate. A separate analytical-method paper can identify survodutide but tested marketed formulations of other drugs.^1362,1350

31 What does glucagon add to the mechanism?

Laboratory and mouse studies support a role in liver metabolism and energy expenditure, alongside GLP-1-related appetite effects. Human trials measure the combined drug. They have not isolated how much of its clinical weight loss comes from glucagon-receptor activity.^1351,1337

32 Does survodutide reach the brain?

A fluorescent analogue reached appetite-related regions around the brain’s circumventricular organs in mice. These regions are accessible from the circulation. The study also mapped receptors in human postmortem tissue; it did not give survodutide to living people.¹³⁵²

33 What did the heart-failure animal study find?

In male obese rats, survodutide improved several measures of heart relaxation and exercise performance while worsening glucose tolerance. The human part of that paper only measured blood samples. Its treatment findings come from the rat experiment.¹³⁵³

34 Has it been combined with other appetite drugs?

A mouse study combined survodutide with the experimental NPY2R agonist BI 1820237 and reported greater weight loss. Some higher-dose groups reached the study’s animal-welfare stopping limit. Human benefit and tolerability require clinical results.¹³⁵⁴

35 Has it been shown to prevent heart attacks or strokes?

The dedicated cardiovascular trial lists 5,531 participants and is marked completed, but its registry has no posted results. The weight-loss trials report heart rate and small event counts. Those results do not yet answer whether survodutide prevents major cardiovascular events.^{1355,1337,1338}

36 What are the larger liver trials testing?

LIVERAGE is recruiting people with MASH and moderate or advanced fibrosis, with a planned 1,800 participants. LIVERAGE-Cirrhosis plans 1,590 people with cirrhosis. These are global enrollment estimates in the trial registry; neither record has posted outcomes.^1356,1357

37 What does the Japanese phase 3 study add so far?

The published design and baseline report describes 274 participants, including people with and without diabetes. It explains the planned 76-week comparison and imaging subgroup. It does not report treatment outcomes.^1358,1359

38 How many people had an improvement in fibrosis?

In the main planned-dose analysis, fibrosis improved by at least one stage in 34%, 36% and 34% of the survodutide groups, versus 22% with placebo. A separate post hoc endpoint also required no worsening of MASH: at the 6.0 mg target, that result was 32% versus 18%.¹³³⁹

39 Is survodutide approved?

No FDA approval was identified in the official approval database as of October 1, 2026. Survodutide remains investigational, with published phase 3 results and ongoing development. A trial authorization or development designation is different from permission to market a drug.^1360,1338

40 What do the anti-doping rules say?

WADA’s 2026 S0 rule prohibits unapproved pharmacological substances at all times, including investigational drugs. On the approval evidence cited here, survodutide falls under that rule. The published 2027 list retains S0 and takes effect January 1, 2027.^{1361,1363,1360}

41 What is known about pregnancy and breastfeeding?

The clinical evidence leaves pregnancy and breastfeeding safety unresolved. The phase 3 studies excluded pregnant or nursing participants and required contraception.^1337,1338

42 What doses did the phase 3 trials study?

SYNCHRONIZE-1 and -2 assigned weekly injections with target doses of 3.6 or 6.0 mg. The 76-week treatment period included 24 weeks of dose escalation and 52 weeks of maintenance. Investigators could extend escalation after gastrointestinal symptoms. These were monitored trial regimens.^1337,1338

43 Did participants also change their diet and exercise?

Yes. All groups, including placebo, received counseling aimed at a 500-calorie daily deficit and at least 150 minutes of physical activity each week. The reported weight changes reflect treatment alongside that shared lifestyle program.^1337,1338

44 What about switching from semaglutide or tirzepatide, or taking them together?

The phase 3 trials did not test a switching schedule or assign survodutide alongside those drugs. Other GLP-1-containing weight-loss medicines were prohibited and any use was recorded as a treatment deviation. These studies provide no tested conversion dose or combination regimen.^1337,1338

45 Could it affect oral medicines or birth control?

An early study found a temporary change in paracetamol absorption during dose escalation. In phase 3, people using oral contraceptives had to switch to a non-oral method or add a barrier method. Those precautions leave the size of any effect on contraceptive effectiveness unresolved.^{1346,1337,1338}