Tirzepatide

The medicine inside Mounjaro. It is given as an injection once a week and acts on two receptors, called GIP and GLP-1. The SURPASS-CVOT trial compared it with dulaglutide in adults with type 2 diabetes and heart or blood-vessel disease.

Also called Tirzepatide

Drug
In this atlas

Overview

Technical summary

RxNorm ingredient 2601723. By established pharmacologic class (RxClass) it is both a GLP-1 receptor agonist and a glucose-dependent insulinotropic polypeptide receptor agonist, so it is filed as a member of the GLP-1 class. SURPASS-CVOT found it noninferior to dulaglutide for a composite of cardiovascular death, myocardial infarction or stroke (hazard ratio 0.92, 95.3% CI 0.83 to 1.01).

About this drug

Level: Substance
Mechanism: A dual incretin agonist of the glucagon-like peptide-1 and glucose-dependent insulinotropic polypeptide receptors.

Claims and evidence

Context Adults with type 2 diabetes and atherosclerotic cardiovascular disease (SURPASS-CVOT)

Recipient: Adult
Population: Patients with type 2 diabetes and atherosclerotic cardiovascular disease. The registry gives a minimum age of 40 years. The modified intention-to-treat population had a mean age of 64.1 years and 29.0 percent were women.
Care setting: Multicenter trial. The care setting is not described further in the sources read.
Geography: Multinational. The registry lists the sites by country on the study page.
Life stage: Patients aged 40 years or older (registry minimum age 40 years); mean age 64.1 years
Follow-up: Follow-up time is not given in the abstract.

Eligibility: 2 inclusion criteria; exclusion criteria not stated

Included: Type 2 diabetes
Atherosclerotic cardiovascular disease
Excluded: None stated

Effect Interventional Certainty not assessed

SURPASS-CVOT compared a weekly injection of tirzepatide (up to 15 mg) with weekly dulaglutide (1.5 mg), an agent shown to reduce cardiovascular events, in patients with type 2 diabetes and atherosclerotic cardiovascular disease. The analysis population was 6586 patients on tirzepatide and 6579 on dulaglutide. The first death from cardiovascular causes, heart attack or stroke occurred in 801 patients (12.2%) on tirzepatide and 862 (13.1%) on dulaglutide (hazard ratio 0.92; 95.3% CI 0.83 to 1.01; P=0.003 for noninferiority; P=0.09 for superiority). Tirzepatide was therefore noninferior to dulaglutide, but the trial did not show that it was superior. Adverse events appeared similar in the two groups, with more gastrointestinal adverse events on tirzepatide.
Applies to Adult
- Patients with type 2 diabetes and atherosclerotic cardiovascular disease. The registry gives a minimum age of 40 years. The modified intention-to-treat population had a mean age of 64.1 years and 29.0 percent were women.
- Multicenter trial. The care setting is not described further in the sources read.
- Multinational. The registry lists the sites by country on the study page.
- Patients aged 40 years or older (registry minimum age 40 years); mean age 64.1 years
Follow-up Follow-up time is not given in the abstract.
Certainty method
Not assessed

Limitations
The comparison is with another GLP-1 medicine, not with placebo, so the result does not show how tirzepatide compares with no treatment. Noninferiority was tested with a margin of 1.05 for the upper limit of the 95.3% confidence interval; the abstract sets an upper limit below 1.00 as superiority, which was not reached. Funded by Eli Lilly (named in the abstract). Only the PubMed abstract was read.

Last checked
2026-10-14

Next evidence check due
Not scheduled
Sources and citations (5)
1. Supports Cardiovascular Outcomes with Tirzepatide versus Dulaglutide in Type 2 Diabetes
  
  Publication · The New England journal of medicine · Edition PubMed record (abstract and bibliographic data) from NCBI E-utilities. The full text and the version of record were not fetched. · Published 2025-12-18 · DOI: 10.1056/NEJMoa2505928 · PMID: 41406444
  
  Locator
  Abstract, RESULTS, sentence 4
  
  How it applies
  Primary end-point events by arm, hazard ratio, and noninferiority and superiority p-values.
  
  Retrieved
  2026-10-14T18:18:48Z
  
  Source effective date
  Not reported
  
  Source state
  Current
  
  Snapshot hash
  327748d6a2e59380f5e46391eebec0be003d2090382becb7bb35a9919b759525
  
  Reuse basis
  PubMed record fetched through NCBI E-utilities. Only the hash of the bytes is kept, because publisher copyright may apply to the abstract (https://pubmed.ncbi.nlm.nih.gov/disclaimer/). Short factual quotations under 25 words, with the citation.
2. Supports Cardiovascular Outcomes with Tirzepatide versus Dulaglutide in Type 2 Diabetes
  
  Publication · The New England journal of medicine · Edition PubMed record (abstract and bibliographic data) from NCBI E-utilities. The full text and the version of record were not fetched. · Published 2025-12-18 · DOI: 10.1056/NEJMoa2505928 · PMID: 41406444
  
  Locator
  Abstract, RESULTS, sentence 1; Abstract, RESULTS, sentence 2; Abstract, RESULTS, sentence 5
  
  How it applies
  Numbers analysed by arm and the adverse events.
  
  Retrieved
  2026-10-14T18:18:48Z
  
  Source effective date
  Not reported
  
  Source state
  Current
  
  Snapshot hash
  327748d6a2e59380f5e46391eebec0be003d2090382becb7bb35a9919b759525
  
  Reuse basis
  PubMed record fetched through NCBI E-utilities. Only the hash of the bytes is kept, because publisher copyright may apply to the abstract (https://pubmed.ncbi.nlm.nih.gov/disclaimer/). Short factual quotations under 25 words, with the citation.
3. Supports Cardiovascular Outcomes with Tirzepatide versus Dulaglutide in Type 2 Diabetes
  
  Publication · The New England journal of medicine · Edition PubMed record (abstract and bibliographic data) from NCBI E-utilities. The full text and the version of record were not fetched. · Published 2025-12-18 · DOI: 10.1056/NEJMoa2505928 · PMID: 41406444
  
  Locator
  Abstract, CONCLUSIONS, sentence 1
  
  How it applies
  The authors conclusion, which says noninferior.
  
  Retrieved
  2026-10-14T18:18:48Z
  
  Source effective date
  Not reported
  
  Source state
  Current
  
  Snapshot hash
  327748d6a2e59380f5e46391eebec0be003d2090382becb7bb35a9919b759525
  
  Reuse basis
  PubMed record fetched through NCBI E-utilities. Only the hash of the bytes is kept, because publisher copyright may apply to the abstract (https://pubmed.ncbi.nlm.nih.gov/disclaimer/). Short factual quotations under 25 words, with the citation.
4. Background Cardiovascular Outcomes with Tirzepatide versus Dulaglutide in Type 2 Diabetes
  
  Publication · The New England journal of medicine · Edition PubMed record (abstract and bibliographic data) from NCBI E-utilities. The full text and the version of record were not fetched. · Published 2025-12-18 · DOI: 10.1056/NEJMoa2505928 · PMID: 41406444
  
  Locator
  Abstract, METHODS, sentence 1; Abstract, METHODS, sentence 2; Abstract, METHODS, sentence 3
  
  How it applies
  Design, comparator, primary end point and noninferiority margin.
  
  Retrieved
  2026-10-14T18:18:48Z
  
  Source effective date
  Not reported
  
  Source state
  Current
  
  Snapshot hash
  327748d6a2e59380f5e46391eebec0be003d2090382becb7bb35a9919b759525
  
  Reuse basis
  PubMed record fetched through NCBI E-utilities. Only the hash of the bytes is kept, because publisher copyright may apply to the abstract (https://pubmed.ncbi.nlm.nih.gov/disclaimer/). Short factual quotations under 25 words, with the citation.
5. Background Cardiovascular Outcomes with Tirzepatide versus Dulaglutide in Type 2 Diabetes
  
  Publication · The New England journal of medicine · Edition PubMed record (abstract and bibliographic data) from NCBI E-utilities. The full text and the version of record were not fetched. · Published 2025-12-18 · DOI: 10.1056/NEJMoa2505928 · PMID: 41406444
  
  Locator
  Abstract, CONCLUSIONS, sentence 2
  
  How it applies
  Funding line.
  
  Retrieved
  2026-10-14T18:18:48Z
  
  Source effective date
  Not reported
  
  Source state
  Current
  
  Snapshot hash
  327748d6a2e59380f5e46391eebec0be003d2090382becb7bb35a9919b759525
  
  Reuse basis
  PubMed record fetched through NCBI E-utilities. Only the hash of the bytes is kept, because publisher copyright may apply to the abstract (https://pubmed.ncbi.nlm.nih.gov/disclaimer/). Short factual quotations under 25 words, with the citation.

Clinical links

Each link reports what one cited claim says about one population. "Evaluated for" means studied, not shown to work. These links do not show that anything is effective or right for you.

Claim, not a settled fact SURPASS-CVOT compared it with dulaglutide on major cardiovascular events: Type 2 diabetes (Evaluated for)
Applies to Adult
- Patients with type 2 diabetes and atherosclerotic cardiovascular disease. The registry gives a minimum age of 40 years. The modified intention-to-treat population had a mean age of 64.1 years and 29.0 percent were women.
- Multicenter trial. The care setting is not described further in the sources read.
- Multinational. The registry lists the sites by country on the study page.
- Patients aged 40 years or older (registry minimum age 40 years); mean age 64.1 years
Follow-up Follow-up time is not given in the abstract.
SURPASS-CVOT compared a weekly injection of tirzepatide (up to 15 mg) with weekly dulaglutide (1.5 mg), an agent shown to reduce cardiovascular events, in patients with type 2 diabetes and atherosclerotic cardiovascular disease. The analysis population was 6586 patients on tirzepatide and 6579 on dulaglutide. The first death from cardiovascular causes, heart attack or stroke occurred in 801 patients (12.2%) on tirzepatide and 862 (13.1%) on dulaglutide (hazard ratio 0.92; 95.3% CI 0.83 to 1.01; P=0.003 for noninferiority; P=0.09 for superiority). Tirzepatide was therefore noninferior to dulaglutide, but the trial did not show that it was superior. Adverse events appeared similar in the two groups, with more gastrointestinal adverse events on tirzepatide.
Limitations. The comparison is with another GLP-1 medicine, not with placebo, so the result does not show how tirzepatide compares with no treatment. Noninferiority was tested with a margin of 1.05 for the upper limit of the 95.3% confidence interval; the abstract sets an upper limit below 1.00 as superiority, which was not reached. Funded by Eli Lilly (named in the abstract). Only the PubMed abstract was read.

Record details

Record id: cardio:tirzepatide
Content hash: a504699f049bc9a92eabcc2bbd4d0b33372c4213d13ca75985918d02767ca1ab