Survodutide: what the evidence shows

What the human research shows

Solid B: the phase 3 obesity data are published in a major journal, the effect is real but smaller than tirzepatide's, and the tolerability burden is high. The liver results are what make it more than another GLP-1 — and what will decide whether it gets approved for MASH first.

Evidence profile0–5

Metabolic & weightB3.5
Cardiovascular—0.0
Muscle & growth—0.0
Healing & repair—0.0
Neuro & sleep—0.0
Immune & inflammation—0.0
Sexual & hormonal—0.0
Skin & appearance—0.0
Ageing & longevity—0.0

Each score is confidence × effect size, taken from the best-evidenced benefit in that domain: the grade (A–D) sets the confidence, the measured effect sets the size. Hover a domain to see the outcomes behind it. Adverse effects are excluded and listed separately below.

Outcome	Grade	Effect size	Human studies	Where the evidence comes from
Body weight	BProbable	Moderate	1 phase 3 RCT + phase 2	SYNCHRONIZE-1, 725 adults, 76 weeks: −12% (3.6 mg) and −13% (6.0 mg) versus −5% placebo; at least 5% loss in 73%, 72% and 46%. Phase 2: up to −14.9% at 46 weeks.1 2
Body weight (obesity with type 2 diabetes)	BProbable	Moderate	1 phase 3 RCT (n=752, 76 wk)	SYNCHRONIZE-2, published in the New England Journal of Medicine on 1 October 2026: −8.2% (3.6 mg) and −9.8% (6.0 mg) versus −3.9% on placebo at 76 weeks, counting all participants whether or not they stayed on treatment; at least 5% loss in 57.6%, 64.5% and 35.1%. HbA1c fell 0.9 and 0.8 points against 0.2, from a baseline of 7.4%. The usual pattern: less weight loss when type 2 diabetes is present.5
Liver disease (MASH resolution)	BProbable	Large	1 phase 2 RCT; phase 3 running	Phase 2 in 293 patients: MASH improvement without worsening fibrosis in 83% at 4.8 mg versus 18% on placebo at 48 weeks; fibrosis improvement in 52% versus 26%. Phase 3 LIVERAGE ongoing.3
Liver fat and visceral fat	BProbable	Large	Phase 3 (SYNCHRONIZE-MASLD)	Marked reductions in liver fat and visceral fat reported in the phase 3 obesity-with-MASLD trial; consistent with the glucagon component's hepatic action.4
GI side effectsadverse	BProbable	Large	Phase 3	Mild-to-moderate gastrointestinal symptoms in 81% (3.6 mg) and 90% (6.0 mg) versus 48% on placebo in SYNCHRONIZE-1, with substantial discontinuation. SYNCHRONIZE-2: 72.8% and 77.7% versus 38.6%, generally mild to moderate and transient.1 5
Heart rate increaseadverse	BProbable	Small	Phase 2 + 3	Resting heart rate rises a few beats per minute, as with other glucagon-receptor agonists; long-term significance unknown.2

AMultiple good human trials, consistentBSome human trials, mostly consistentCFew or weak human studiesDAnimal or anecdotal onlyeffect size · red = adverse

Literature searched to 7 October 2026. Human studies only; animal and cell work informs the mechanism section and nothing else.

Registered trials

ClinicalTrials.gov lists 28 interventional studies naming Survodutide as an intervention — 18 completed, 4 recruiting, and 2 with results posted to the registry.

A registration is not a result. Anyone can register a study, and many never report — so this list shows what has been attempted, not what has been shown. The graded evidence above is the answer to whether something works.

Study	Phase	Status	Participants	Sponsor	Results
A Study to Test Whether Different Doses of BI 456906 Help People With Overweight or Obesity to Lose WeightNCT04667377 · started Mar 2021	Phase 2	Completed	387	Boehringer Ingelheim	Posted
A Study to Test Safety and Efficacy of Survodutide (BI456906) in Adults With Non-alcoholic Steatohepatitis (NASH) and Fibrosis (F1-F3)NCT04771273 · started Apr 2021	Phase 2	Completed	295	Boehringer Ingelheim	Posted
A Study to Test the Effect of Survodutide (BI 456906) on Cardiovascular Safety in People With Overweight or Obesity (SYNCHRONIZE™ - CVOT)NCT06077864 · started Nov 2023	Phase 3	Completed	5,531	Boehringer Ingelheim	None
LIVERAGE™: A Study to Test Whether Survodutide Helps People With a Liver Disease Called NASH/MASH Who Have Moderate or Advanced Liver FibrosisNCT06632444 · started Oct 2024	Phase 3	Recruiting	1,800*	Boehringer Ingelheim	None
LIVERAGE™ - Cirrhosis: A Study to Test Whether Survodutide Helps People With a Liver Disease Called NASH/MASH Who Have CirrhosisNCT06632457 · started Nov 2024	Phase 3	Recruiting	1,590*	Boehringer Ingelheim	None
A Study to Test Whether Survodutide (BI 456906) Helps People Living With Overweight or Obesity Who Also Have Diabetes to Lose WeightNCT06066528 · started Nov 2023	Phase 3	Completed	755	Boehringer Ingelheim	None
A Study to Test Whether Survodutide (BI 456906) Helps People Living With Overweight or Obesity Who do Not Have Diabetes to Lose WeightNCT06066515 · started Nov 2023	Phase 3	Completed	726	Boehringer Ingelheim	None
ELEVATE-LIVER: A Study to Test Whether Survodutide Helps Improve Heart Structure and Function in People With Overweight or Obesity and Fatty Liver DiseaseNCT07850063 · started Oct 2026	Phase 3	Not yet recruiting	600*	Boehringer Ingelheim	None

20 further studies are registered. Participant counts marked * are the sponsor's estimate, not a final enrolment. Source: ClinicalTrials.gov, read directly from the registry and refreshed weekly.

What it is

An oxyntomodulin-based 29-amino-acid peptide developed by Zealand Pharma and Boehringer Ingelheim, given once weekly by subcutaneous injection. Oxyntomodulin is the gut hormone that naturally hits both receptors; survodutide is a stabilised version of that idea.

The SYNCHRONIZE phase 3 programme covers obesity, obesity with type 2 diabetes, obesity with liver disease, and cardiovascular outcomes. The first results were published in the New England Journal of Medicine on 7 June 2026; the trial in obesity with type 2 diabetes followed on 1 October 2026.

How it is thought to work

GLP-1 activity reduces appetite and slows gastric emptying; glucagon activity increases energy expenditure and drives fat oxidation in the liver. The combination is designed to lose weight and clear liver fat at the same time — the liver effect is where the data are strongest.

What is still unknown

Whether regulators approve it for obesity, MASH, or both, and when.
How it compares head-to-head with tirzepatide or retatrutide; no such trial exists.
Whether the high discontinuation rate can be managed with slower titration.

The molecule and how long it lasts

Identity

Formula: C192H289N47O61
Molecular weight: 4232 g/mol
CAS number: 2805997-46-8
PubChem: CID 171378821

PubChem record, read 23 September 2026.

Pharmacokinetics

Route: Subcutaneous, once weekly
Half-life: About 6 days

From a published human pharmacokinetic study: Lawitz EJ, et al. Efficacy, tolerability and pharmacokinetics of survodutide in cirrhosis. J Hepatol 2024;81

Regulatory status

European Union

Investigational; not authorised

Phase 3; no marketing authorisation. Supply outside trials is unlawful.

United States

Investigational; not approved

Phase 3; FDA has warned sellers marketing 'research' survodutide for human use. Cannot be compounded.

United Kingdom

Unlicensed

Investigational; supply outside trials is an offence.

Australia

Unapproved

Not on the ARTG; no lawful supply outside trials.

Canada

Not authorised

Investigational; no DIN.

Sport (WADA)

Prohibited at all times

Unapproved anywhere, so it falls under S0 (non-approved substances).

Questions people actually ask

How much weight does survodutide cause people to lose?

In the phase 3 SYNCHRONIZE-1 trial, 12–13% over 76 weeks against 5% on placebo — less than tirzepatide's roughly 20% in its own trials, though trials are not directly comparable.

Why is survodutide talked about for liver disease?

Because its glucagon component acts on the liver. In a phase 2 trial, 83% of patients on the top dose had MASH resolve without worsening fibrosis, against 18% on placebo — among the strongest liver results of any drug in the class.

Is survodutide available?

No. It is investigational everywhere. The FDA has specifically warned companies selling it as a research chemical for human use.

One page per claimed effect

BDoes Survodutide help with body weight?1 phase 3 RCT + phase 2
BDoes Survodutide help with body weight?1 phase 3 RCT (n=752, 76 wk)
BDoes Survodutide help with liver disease?1 phase 2 RCT; phase 3 running
BDoes Survodutide help with liver fat and visceral fat?Phase 3 (SYNCHRONIZE-MASLD)
BHow common is GI side effects with Survodutide?Phase 3
BHow common is heart rate increase with Survodutide?Phase 2 + 3

References

1
Survodutide in adults with obesity: SYNCHRONIZE-1, a randomised, double-blind, placebo-controlled phase 3 trial.N Engl J Med, published online 7 June 2026725 adults, 76 weeks, 3.6 mg and 6.0 mg versus placebo.
2
le Roux CW, et al. Glucagon and GLP-1 receptor dual agonist survodutide for obesity: a randomised, double-blind, placebo-controlled, dose-finding phase 2 trial.Lancet Diabetes Endocrinol, 2024387 adults, 46 weeks.
3
Sanyal AJ, et al. A phase 2 randomized trial of survodutide in MASH and fibrosis.N Engl J Med, 2024; DOI 10.1056/NEJMoa2401755293 patients, 48 weeks.
4
Survodutide in adults with obesity and metabolic dysfunction-associated steatotic liver disease: SYNCHRONIZE-MASLD, a phase 3 trial.2026Liver-fat and visceral-fat outcomes.
5
Wharton S, et al. Survodutide once weekly in adults with obesity and type 2 diabetes (SYNCHRONIZE-2).N Engl J Med, 2026 (online 1 Oct)752 adults, 76 weeks, 3.6 mg and 6.0 mg versus placebo. NCT06066528.

Change log

2026-10-07SYNCHRONIZE-2 (N Engl J Med, 1 Oct 2026) added as a new row for obesity with type 2 diabetes, graded B: −8.2% and −9.8% versus −3.9% at 76 weeks. Other grades unchanged.
2026-09-03Initial publication from SYNCHRONIZE-1 and the phase 2 MASH trial.