Trial review
SURPASS-CVOT: Tirzepatide Against an Active Comparator
Is tirzepatide non-inferior to dulaglutide for cardiovascular outcomes in type 2 diabetes?
SURPASS-CVOT was a randomised, double-blind, active-comparator controlled outcomes trial funded by Eli Lilly. Designed to establish non-inferiority against an active comparator, not superiority against placebo. That figure belongs to the population, dose and Event-driven shown below, and describes a group average rather than a prediction for any individual.
| Design | Randomised, double-blind, ACTIVE-COMPARATOR controlled outcomes trial |
|---|---|
| Population | Adults with type 2 diabetes and established atherosclerotic cardiovascular disease |
| Sample size | 13299 |
| Intervention | Tirzepatide |
| Comparator | Dulaglutide 1.5 mg weekly — an active drug with existing cardiovascular evidence |
| Duration | Event-driven |
| Primary endpoint | Composite of cardiovascular death, myocardial infarction, or stroke, tested for non-inferiority |
| Main result | Designed to establish non-inferiority against an active comparator, not superiority against placebo |
Show this figure as a table
| Step | Stage | What happens |
|---|---|---|
| 1 | Who was eligible | Adults with type 2 diabetes and established atherosclerotic cardiovascular disease |
| 2 | What they received | Tirzepatide |
| 3 | What it was compared against | Dulaglutide 1.5 mg weekly — an active drug with existing cardiovascular evidence |
| 4 | For how long | Event-driven |
| 5 | What was measured first | Composite of cardiovascular death, myocardial infarction, or stroke, tested for non-inferiority |
| 6 | What the group average was | Designed to establish non-inferiority against an active comparator, not superiority against placebo |
| 7 | What it does not tell you | A group average is not a prediction for any individual reader. |
Show this figure as a table
| Item | Mean reduction | Evidence |
|---|---|---|
| Tirzepatide 15 mg (SURMOUNT-1) | 21% | Verified |
| Oral semaglutide 25 mg, adherent (OASIS 4) | 17% | Verified |
| Injectable semaglutide 2.4 mg (SURMOUNT-5) | 14% | Verified |
| Oral semaglutide 25 mg, treatment-policy (OASIS 4) | 14% | Verified |
| Orforglipron 17.2 mg (ATTAIN-1) | 12% | Reported |
| Liraglutide (SCALE) | 8% | Reported |
| Product | Starting self-pay price | Reported mean reduction | Trial |
|---|---|---|---|
| Zepbound (tirzepatide) injectable | $299/mo direct | about 20.9% at 15 mg | SURMOUNT-1, 72 weeks |
| Wegovy pill (oral semaglutide 25 mg) | $149/mo starting dose | 13.6–16.6% depending on estimand | OASIS 4, 64 weeks |
| Wegovy injectable (semaglutide 2.4 mg) | $349/mo maintenance | about 13.7% | SURMOUNT-5, 72 weeks |
| Foundayo (orforglipron) | $149/mo starting dose | about 11–12.4% at 17.2 mg | ATTAIN-1, 72 weeks |
Frequently asked questions
Does this apply to compounded versions?
No. The trial studied an FDA-approved product at studied doses.
Is this drug as effective as tirzepatide?
By mean reduction across separate trials, no. The efficacy ladder above sets out the figures with the trial that produced each one.
Related on this site
- Research hubResearch
- SURMOUNT-1 Tirzepatide Trial ExplainedResearch
- SURMOUNT-3 Tirzepatide Trial ExplainedResearch
- SURMOUNT-4: Weight Maintenance and Tirzepatide WithdrawalResearch
- The 100-point rubricCore & Trust
- Cost calculatorTools
- The underlying price recordsData
- Retatrutide Phase 3 Results: What Changed in July 2026Journal
- Retatrutide Phase 3 Results and How It ComparesResearch
- Oral Tirzepatide and Sublingual Products: What Evidence Exists?Pillar / Money
Related coverage
GLP-1 Tirzepatide Rank. “SURPASS-CVOT: Tirzepatide Against an Active Comparator.” S.J Partners LLC, 2026-08-03. https://glp1tirzepatiderank.com/research/surpass-cvot/
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