Evidence Grade C — Moderate human evidence. 63 published studies, 39 human. 24 registered clinical trials.
Medically reviewed by a licensed medical professional
Survodutide is a once-weekly injection in Phase III development by Boehringer Ingelheim that activates both GLP-1 and glucagon receptors. The glucagon component adds a mechanism that burns liver fat and increases energy expenditure — effects that pure GLP-1 drugs do not provide. It is being developed for both obesity and fatty liver disease (MASH).
Survodutide is also known by these brand and alternate names:
63 published studies: 39 human, 0 animal, 1 in-vitro, 32 reviews
Survodutide is in Phase III development (not yet approved). In a Phase II obesity trial (387 patients, 46 weeks), the highest planned dose achieved approximately 15% weight loss. A separate Phase II MASH trial (293 patients) showed MASH improvement without worsening fibrosis in up to 62% of patients, compared to 14% with placebo.
Phase III trials are ongoing for both obesity and MASH indications. Survodutide's dual development strategy — targeting both weight loss and liver disease — reflects the growing recognition that these conditions are closely interconnected.
Survodutide activates both the GLP-1 receptor (appetite suppression, insulin enhancement) and the glucagon receptor (energy expenditure, liver fat oxidation). The glucagon component directly stimulates the liver to burn stored fat, which is particularly relevant for MASH — a condition characterised by liver fat accumulation and inflammation. The drug is designed with a deliberate bias toward GLP-1 receptor activity.
In a Phase II obesity trial (387 patients), the highest planned dose achieved approximately 15% weight loss at 46 weeks, with head-to-head Phase II data showing superiority over semaglutide. A separate Phase II MASH trial showed improvement in liver disease without worsening scarring in up to 62% of patients (versus 14% on placebo) — among the strongest liver results for any drug in this class. Phase III trials are ongoing for both indications but no Phase III results are yet available. Key concerns include a 24.6% treatment discontinuation rate in the Phase II obesity trial and a puzzling finding where the highest MASH dose was less effective than the second-highest, requiring careful dose optimisation in Phase III. If the liver disease programme succeeds, regulatory filing could occur around 2027.
PeptideTrace tracks 24 registered clinical trials for Survodutide sourced from ClinicalTrials.gov.
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
Survodutide (BI 456906) is a dual GLP-1/glucagon receptor agonist containing 29 amino acids. The fully conjugated molecular weight is 4,231.62 Da with molecular formula C192H289N47O61 (CAS 2805997-46-8). The plasma half-life is approximately 6 days, enabling once-weekly subcutaneous dosing, with more than 99% albumin binding. Position 2 contains Ac4c (1-aminocyclobutane-1-carboxylic acid) for DPP-4 resistance, and position 24 features a C18 fatty diacid via Gly-Ser-Gly-Ser-Gly-Gly-gammaGlu linker. Licensed from Zealand Pharma to Boehringer Ingelheim, which is solely responsible for global development.
Research suggests survodutide activates GLP-1R (EC50 0.33 nM) and GCGR (EC50 0.52 nM) with deliberate GLP-1R bias in human plasma. The GLP-1R component drives appetite suppression, gastric emptying delay, and glucose-dependent insulin secretion. The GCGR component increases energy expenditure (key differentiator versus GLP-1-only agonists), stimulates hepatic lipolysis and beta-oxidation for direct liver fat reduction, reduces hepatic inflammation, and exerts anti-fibrotic effects by reducing stellate cell activation. In preclinical DIO mice, survodutide achieved greater weight-lowering than maximally effective semaglutide doses.
Phase 2 obesity (le Roux et al. 2024, Lancet Diabetes Endocrinol, N=387, 46 weeks): -14.9% weight loss at 4.8 mg (planned treatment) versus -2.8% placebo; actual treatment analysis showed -18.7%. Phase 2 MASH (Sanyal et al. 2024, NEJM, N=293, 48 weeks): MASH improvement without worsening fibrosis in up to 62% versus 14% placebo (p<0.001). Phase 2 T2D (Bluher et al. 2024, N=411): HbA1c -1.71% with significantly greater weight loss than semaglutide 1.0 mg. Phase 3 program includes SYNCHRONIZE (5 obesity trials, including N=5,508 CVOT) and LIVERAGE (MASH). SYNCHRONIZE-1 topline results expected H1 2026. FDA Breakthrough Therapy Designation for MASH October 2024.
The information on this page is provided for educational and research reference purposes only. This is not medical advice. Always consult a qualified healthcare professional before making any health-related decisions.
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Semaglutide is one of the most extensively studied peptide medications available today, with clinical trial data spanning over 50,000 patients. It is sold as Ozempic for type 2 diabetes (approved 2017), Rybelsus as an oral tablet for diabetes (approved 2019), and Wegovy for weight management (approved 2021). Wegovy has since received additional approvals for reducing heart attack and stroke risk, for use in adolescents aged 12 and older, and for liver disease related to obesity. In clinical trials, patients taking Wegovy lost an average of 14.9% of their body weight over 68 weeks, and the SELECT trial demonstrated a 20% reduction in major cardiovascular events such as heart attack and stroke. Research is now exploring its potential in early Alzheimer's disease. The main side effects are gastrointestinal, particularly nausea, and a key limitation is that most weight tends to return after stopping treatment.
Bimagrumab is in Phase II/III development (not yet approved). A Phase II trial (75 patients with type 2 diabetes and obesity) showed 20.5% fat mass reduction with 3.6% lean mass increase — essentially reshaping body composition without net appetite suppression. The BELIEVE Phase IIb trial (507 patients) showed that bimagrumab plus semaglutide achieved 22% weight loss with the weight lost being 88% fat — significantly better body composition than semaglutide alone. Bimagrumab is not a peptide. Its strategic significance is as a combination partner to address the muscle loss problem inherent in weight loss with current obesity drugs. Eli Lilly's acquisition positions it alongside tirzepatide.
Pemvidutide is in Phase II/III development (not yet approved). In the MOMENTUM Phase II trial (391 patients, 48 weeks), the 2.4 mg dose achieved 15.6% weight loss. Body composition analysis showed 78% of weight lost was fat mass, with only 22% lean mass — a favourable ratio. A Phase IIb MASH trial (212 patients) showed MASH resolution in up to 75% of patients at the highest dose. Pemvidutide's balanced receptor profile and no-titration dosing regimen represent potential practical advantages. The high rate of MASH resolution in Phase II positions it as a candidate for liver disease indications alongside obesity.
Evidence Reviews
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This content is for informational purposes only and does not constitute medical advice. Always consult a qualified healthcare professional before making decisions about your health.
