Tirzepatide Switch Outperforms Dulaglutide Dose Escalation in T2D: Daily Dose

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On April 4, 2025, we reported on late-breaking data from the open-label, multicenter SURPASS-SWITCH phase 4 clinical trial presented at the 2025 American College of Physicians Internal Medicine Meeting.

The study

Researchers enrolled 282 adults with type 2 diabetes (T2D) who had HbA_1c levels ranging from 7.0% to 9.5%, stable body weight, and a body mass index (BMI) of 25 kg/m² or greater. All participants had been receiving a stable dose of dulaglutide 0.75 or 1.5 mg weekly for at least 6 months, with or without up to 3 oral antihyperglycemic agents. Participants were randomized to either escalation of dulaglutide to 4.5 mg or the maximum tolerated dose (MTD) (n = 143) or to switch to tirzepatide, 15 mg or MTD (n = 139), administered once weekly.

The findings

Participants in the tirzepatide group also experienced greater weight loss compared with those continuing dulaglutide. Mean weight change was −10.5 kg (SE, 0.5) compared to −3.6 kg (SE, 0.5), respectively, with an estimated treatment difference of −6.9 kg (95% CI, −8.3 to −5.5 kg; P < .001).

Serious adverse events occurred in 10 participants in each group (7.2% in the tirzepatide group and 7.0% in the dulaglutide group). The most commonly reported treatment-emergent adverse events were nausea and diarrhea.

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