Study participants in SURPASS-1, 54.2 percent of whom were treatment-naïve, had a relatively short mean duration of diabetes of 4.7 years, a baseline A1C of 7.9 percent and a baseline weight of 85.9 kg. For the efficacy estimandi, tirzepatide reduced A1C by up to 2.07 percent and body weight by up to 9.5 kg (20.9 lb., 11.0 percent) compared to placebo (+0.04 A1C change and body weight change of -0.7 kg [1.5 lb., 0.9 percent]). Up to 52 percent of participants achieved an A1C less than 5.7 percent – the level seen in people without diabetes. Tirzepatide also led to improvements in the change in fasting serum glucose from baseline. In an additional secondary endpoint, tirzepatide led to improvements in the change in two-hour post-meal glucose values from baseline from self-monitored blood glucose data.1,2
The overall safety profile of tirzepatide was similar to the well-established glucagon-like peptide-1 (GLP-1) receptor agonist class, with gastrointestinal side effects being the most commonly reported adverse events. Treatment discontinuation rates due to adverse events were less than 7 percent in each tirzepatide treatment arm.1
“Type 2 diabetes is a progressive disease, and many people with the condition have trouble reaching their A1C goals through diet and exercise. This monotherapy clinical trial was designed to assess the impact of tirzepatide alone on several important diabetes treatment targets, including glycemic control and weight loss,” said
Tirzepatide is a novel investigational once-weekly dual glucose-dependent insulinotropic polypeptide (GIP) and GLP-1 receptor agonist that integrates the actions of the GIP and GLP-1 incretins into a single molecule, representing a new class of medicines being studied for the treatment of type 2 diabetes.
For both estimandsii, all three tirzepatide doses reached statistical significance in A1C and body weight reductions from baseline and in the percentage of participants who achieved an A1C of less than 7 percent (the
At 40 weeks, tirzepatide led to a significant decrease in fasting serum glucose (FSG) compared to placebo. In an additional secondary endpoint, the mean two-hour post-meal glucose values for tirzepatide across all three doses were under 140 mg/dL (considered normal values in individuals without diabetes).2
Specifically, the efficacy estimand results showed:
- A1C change: -1.87% (5 mg), -1.89% (10 mg), -2.07% (15 mg), +0.04% (placebo)
- Weight reduction: -7.0 kg (-7.9%, 5 mg), -7.8 kg (-9.3%, 10 mg), -9.5 kg (-11.0%, 15 mg), -0.7 kg (-0.9%, placebo)
- Percent of participants achieving A1C <7%: 87% (5 mg), 92% (10 mg), 88% (15 mg), 20% (placebo)
- Percent of participants achieving A1C <5.7%: 34% (5 mg), 31% (10 mg), 52% (15 mg), 1% (placebo)
- Change in FSG: -43.6 mg/dL (5 mg), -45.9 mg/dL (10 mg), -49.3 mg/dL (15 mg), +12.9 mg/dL (placebo)
The treatment-regimen estimandiii results showed:
- A1C reduction: -1.75% (5 mg), -1.71% (10 mg), -1.69% (15 mg), -0.09% (placebo)
- Weight reduction: -6.3 kg (5 mg), -7.0 kg (10 mg), -7.8 kg (15 mg), -1.0 kg (placebo)
- Percent of participants achieving A1C <7%: 82% (5 mg), 85% (10 mg), 78% (15 mg), 23% (placebo)
- Percent of participants achieving A1C <5.7%: 31% (5 mg), 27% (10 mg), 38% (15 mg), 1% (placebo)
- Change in FSG: -39.6 mg/dL (5 mg), -39.8 mg/dL (10 mg), -38.6 mg/dL (15 mg), +3.7 mg/dL (placebo)
No events of severe hypoglycemia or hypoglycemia less than 54 mg/dL were observed in the tirzepatide treatment arms.1,2
In an additional exploratory endpoint, all three doses of tirzepatide led to favorable changes from baseline in fasting lipids. Specifically, at the highest dose of tirzepatide (15 mg): total cholesterol was reduced by 8.4 percent, triglycerides were reduced by 21.0 percent, low-density lipoprotein (LDL) cholesterol was reduced by 12.4 percent, very low-density lipoprotein (VLDL) cholesterol was reduced by 19.8 percent, and high-density lipoprotein (HDL) cholesterol was increased by 7.5 percent.2
The most commonly reported adverse events for tirzepatide were gastrointestinal-related and mostly mild to moderate in severity, usually occurring during the dose escalation period. For study participants treated with tirzepatide (5 mg, 10 mg and 15 mg, respectively), nausea (11.6 percent, 13.2 percent, 18.2 percent, respectively), diarrhea (11.6 percent, 14.0 percent, 11.6 percent, respectively), vomiting (3.3 percent, 2.5 percent, 5.8 percent, respectively) and constipation (5.8 percent, 5.0 percent, 6.6 percent, respectively) were more frequently experienced compared to placebo (6.1 percent [nausea], 7.8 percent [diarrhea], 1.7 percent [vomiting], 0.9 percent [constipation]). The overall treatment discontinuation rates were 9.1 percent (tirzepatide 5 mg), 9.9 percent (tirzepatide 10 mg) and 21.5 percent (tirzepatide 15 mg), compared to 14.8 percent (placebo). The majority of the discontinuations in the 15 mg and placebo arms were due to reasons other than adverse events (such as concerns due to the coronavirus pandemic and family or work reasons).2
SURPASS-1 is the first of five global registration studies for tirzepatide in type 2 diabetes, all of which have been completed.
Tirzepatide is a once-weekly dual glucose-dependent insulinotropic polypeptide (GIP) and glucagon-like peptide-1 (GLP-1) receptor agonist that integrates the actions of both incretins into a single novel molecule. GIP is a hormone that may complement the effects of GLP-1. In preclinical models, GIP has been shown to decrease food intake and increase energy expenditure therefore resulting in weight reductions, and when combined with a GLP-1 receptor agonist, may result in greater effects on glucose and body weight. Tirzepatide is in phase 3 development for blood glucose management in adults with type 2 diabetes and for chronic weight management. It is also being studied as a potential treatment for non-alcoholic steatohepatitis (NASH) and heart failure with preserved ejection fraction (HFpEF).
About SURPASS-1 and the SURPASS clinical trial program
SURPASS-1 (NCT03954834) is a 40-week, multi-center, randomized, double-blind, parallel, placebo-controlled trial comparing the efficacy and safety of tirzepatide 5 mg, 10 mg and 15 mg as monotherapy to placebo in adults with type 2 diabetes inadequately controlled with diet and exercise alone. The trial randomized 478 study participants across the
The SURPASS phase 3 global clinical development program for tirzepatide has enrolled more than 19,000 people with type 2 diabetes across 10 clinical trials, five of which are global registration studies. The program began in late 2018, and all five global registration trials have been completed.
Approximately 34 million Americans3 (just over 1 in 10) and an estimated 463 million adults worldwide4 have diabetes. Type 2 diabetes is the most common type internationally, accounting for an estimated 90 to 95 percent of all diabetes cases in
This press release contains forward-looking statements (as that term is defined in the Private Securities Litigation Reform Act of 1995) about tirzepatide as a potential treatment for people with type 2 diabetes and the timeline for future readouts, presentations and other milestones relating to tirzepatide and its clinical trials and reflects
1 Rosenstock, J, et. al. Efficacy and Safety of Once Weekly Tirzepatide, a Dual GIP/GLP-1 Receptor Agonist Versus Placebo as Monotherapy in People with Type 2 Diabetes (SURPASS-1). Abstract 100-OR. Presented virtually at the
2 Rosenstock, J, et. al. (2021). Efficacy and Safety of Once Weekly Dual GIP/GLP-1 Receptor agonist Tirzepatide Versus Placebo in People with Type 2 Diabetes Inadequately Controlled with Diet and Exercise (SURPASS-1): A Double-blind, Randomised Controlled Trial.
3 Centers for Disease Control and Prevention. National Diabetes Statistics Report, 2020.
4 International Diabetes Federation. IDF Diabetes Atlas, 9th edn.
i Efficacy estimand represents efficacy prior to discontinuation of study drug or initiating rescue therapy for persistent severe hyperglycemia.
ii Treatment differences for two estimands – efficacy and treatment-regimen – were evaluated for the three tirzepatide doses (5 mg, 10 mg and 15 mg) compared to placebo.
iii Treatment-regimen estimand represents the efficacy irrespective of adherence to the investigational medicine or introduction of rescue therapy for persistent severe hyperglycemia.
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