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Survodutide

Dual glucagon and GLP-1 receptor agonist

Also known as BI 456906, BI456906

A dual glucagon/GLP-1 agonist in phase 3 for obesity and for MASH. Real trials, real sponsor, no approval anywhere yet, and the phase 3 readouts that matter are not published.

Guide updated Sep 2, 2026Literature checked Sep 2, 20263 curated studies41 literature recordsBaseline editorial

Overview

In shortA drug that acts on two receptors, one of them glucagon, in late-stage testing for weight and liver disease. Mid-stage results were positive. Nothing from late-stage testing has been published yet, which is the fact that should lead any discussion of it.

Survodutide is an investigational peptide that activates both the GLP-1 receptor and the glucagon receptor. The rationale for hitting glucagon as well as GLP-1 is that glucagon agonism raises energy expenditure, where GLP-1 mostly suppresses intake, so the two are expected to add rather than overlap.

It is developed by Boehringer Ingelheim and is in phase 3 for obesity and for metabolic dysfunction-associated steatohepatitis. That places it in a different category from most of this compendium: the trials are registered, sponsored and running, and the open question is what they report, not whether they exist.

Mechanism

In shortIt combines the familiar gut-hormone effects with glucagon receptor activity, the same pairing as mazdutide but on a different backbone. The glucagon side is proposed to raise energy expenditure and cut liver fat, with its blood sugar downside offset by the other half.

Co-agonism at the GLP-1 and glucagon receptors. GLP-1 agonism slows gastric emptying, increases satiety and improves glucose-dependent insulin secretion. Glucagon receptor agonism increases hepatic fat oxidation and resting energy expenditure, and is the reason this class is of interest in liver disease specifically rather than only in weight.

The same glucagon arm is why the class needs watching. Glucagon raises hepatic glucose output, and balancing that against the GLP-1 arm is a dose-finding problem rather than a solved one.

Evidence

In shortMid-stage results in obesity and in liver disease have been published and hit their main targets. Late-stage trials are running and none has reported. Treat anything describing its effectiveness in confident terms as describing mid-stage work. The gap between a mid-stage signal and a late-stage result is where a large share of metabolic drugs have historically failed.

Phase 2 results in obesity and in MASH have been published and were positive on their primary endpoints. Phase 3 is running. As of writing, no phase 3 result is published, and the registry is the honest place to look rather than any summary of it, including this one.

Treat anything describing survodutide's efficacy in confident terms as describing phase 2. The gap between a phase 2 signal and a phase 3 result is where a large fraction of metabolic drugs have historically failed.

Safety

In shortMid-stage side effects were dominated by stomach problems, as across this class, mostly while the dose was going up, and enough people stopped for it to matter. Longer-term safety is not characterised because the trials that would characterise it have not reported. Anything sold as survodutide outside a trial is not survodutide: it is unverified material sold under a name.

Adverse events reported in phase 2 were dominated by gastrointestinal effects, consistent with the GLP-1 class: nausea, vomiting, diarrhoea, mostly during escalation. Discontinuation for tolerability was not trivial.

Longer-term safety is not characterised, because the trials that would characterise it have not reported. The glucagon arm raises questions about hepatic glucose handling and heart rate that phase 3 is designed to answer and phase 2 is not powered to.

Anything sold as survodutide outside a trial is not survodutide from the sponsor. It is material of unverified identity sold under a name.

Regulatory status

In shortNot approved anywhere. Investigational, in registered late-stage trials. Any supply outside a clinical trial is outside the regulatory system entirely, and it is banned in sport.

Not approved anywhere. Investigational, in registered phase 3 trials. Any supply outside a clinical trial is outside the regulatory system entirely.

Prohibited in sport under WADA's S0 category, which covers substances with no current approval for human therapeutic use.

The literature

3 studies indexed. Findings and limitations get equal weight, on purpose.

Always check the primary source

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  • The dose each named trial administered, where recorded
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The wider literature

17 indexed papers and 24 registered trials mentioning Survodutide, straight from PubMed and ClinicalTrials.gov. 23 of 24 administer it; the rest measure it. These have not been read by us. Unlike the studies above, they carry no findings and no limitations written by anyone here, because writing either would mean claiming a reading nobody has done. They are a starting point for yours.

Registered trials (24)

  1. A Study in People With Overweight or Obesity to Compare How 2 Different Formulations of Survodutide Are Taken up by the Body

    Boehringer Ingelheim2026NCT07407348

    interventionalphase1recruitingn=80

  2. A Study to Test Whether Survodutide Helps People With Type 2 Diabetes Control Their Blood Sugar

    Boehringer Ingelheim2026NCT07754461

    interventionalphase3recruitingn=600

  3. A Study to Compare How 2 Different Formulations of Survodutide Are Taken up in the Body When Given by Injection in Healthy Men and Women With and Without Overweight or Obesity

    Boehringer Ingelheim2026NCT07768813

    interventionalphase1not yet recruitingn=44

  4. A Study in Healthy People or Otherwise Healthy With Overweight or Obesity to Compare 2 Formulations of Survodutide Given in Different Ways, Either as a Pre-filled Syringe or a Pen-like Injector

    Boehringer Ingelheim2026NCT07413913

    interventionalphase1completedn=56

  5. Albuminuria Reduction Study With Survodutide Treatment in Kidney Disease

    University Medical Center Groningen2026NCT07206290

    interventionalphase2not yet recruitingn=120

  6. A Study in Healthy People to Compare How 2 Different Formulations of Survodutide Are Taken up by the Body

    Boehringer Ingelheim2025NCT07221591

    interventionalphase1completedn=100

  7. A Study in Healthy People to Compare How 2 Different Formulations of Survodutide Are Taken up in the Body

    Boehringer Ingelheim2025NCT07071974

    interventionalphase1completedn=16

  8. A Study to Test Whether Survodutide Improves How the Body Uses Energy and Breaks Down Fat in People With Obesity

    Boehringer Ingelheim2025NCT06745284

    interventionalphase1active not recruitingn=64

  9. A Study in Healthy People to Compare How 3 Different Formulations of Survodutide Are Taken up in the Body

    Boehringer Ingelheim2025NCT06772532

    interventionalphase1completedn=30

  10. A Study to Test Whether Multiple Doses of BI 456906 Have an Effect on Cardiac Safety in People With Overweight or Obesity

    Boehringer Ingelheim2024NCT06200467

    interventionalphase1completedn=110

  11. A Study to Test Whether Survodutide (BI 456906) Helps Chinese People Living With Overweight or Obesity to Lose Weight

    Boehringer Ingelheim2024NCT06214741

    interventionalphase3completedn=307

  12. A Study to Test Whether Survodutide Helps Japanese People Living With Obesity Disease

    Boehringer Ingelheim2024NCT06176365

    interventionalphase3completedn=274

  13. A Study in People With Obesity to Test the Effects of BI 456906 Compared With Semaglutide on Glucagon Receptor Activity in the Liver

    Boehringer Ingelheim2024NCT05202353

    interventionalphase1active not recruitingn=29

  14. LIVERAGE™: A Study to Test Whether Survodutide Helps People With a Liver Disease Called NASH/MASH Who Have Moderate or Advanced Liver Fibrosis

    Boehringer Ingelheim2024NCT06632444

    interventionalphase3recruitingn=1800

  15. A Study to Test Whether Survodutide Helps People Living With Obesity or Overweight and With a Confirmed or Presumed Liver Disease Called Non-alcoholic Steatohepatitis (NASH) to Reduce Liver Fat and to Lose Weight (SYNCHRONIZE-MASLD)

    Boehringer Ingelheim2024NCT06309992

    interventionalphase3completedn=218

  16. A Study to Test Whether BI 456906 (Survodutide) Influences the Amount of Bupropion, Caffeine and Midazolam in the Blood in People With Overweight or Obesity

    Boehringer Ingelheim2024NCT06564441

    interventionalphase1completedn=34

  17. LIVERAGE™ - Cirrhosis: A Study to Test Whether Survodutide Helps People With a Liver Disease Called NASH/MASH Who Have Cirrhosis

    Boehringer Ingelheim2024NCT06632457

    interventionalphase3recruitingn=1590

  18. A Study in Chinese People With Overweight or Obesity to Test How Different Doses of Survodutide Are Taken up in the Body

    Boehringer Ingelheim2024NCT06492135

    interventionalphase1completedn=30

  19. A Study in Women With Overweight or Obesity to Test Whether Different Doses of BI 456906 Influence the Amount of a Contraceptive in the Blood

    Boehringer Ingelheim2023NCT05896384

    interventionalphase1completedn=32

  20. A Study to Test the Effect of Survodutide (BI 456906) on Cardiovascular Safety in People With Overweight or Obesity (SYNCHRONIZE™ - CVOT)

    Boehringer Ingelheim2023NCT06077864

    interventionalphase3completedn=5531

  21. A Study to Test Whether Survodutide (BI 456906) Helps People Living With Overweight or Obesity Who Also Have Diabetes to Lose Weight

    Boehringer Ingelheim2023NCT06066528

    interventionalphase3completedn=755

  22. A Study to (1) Compare How BI 456906 is Taken up in the Body of Healthy People and People With Liver Problems and (2) Find Out How People With Overweight and Obesity, With and Without Liver Problems, Tolerate Different Doses of BI 456906

    Boehringer Ingelheim2022NCT05296733

    interventionalphase1completedn=82

  23. A Study to Test Whether Different Doses of BI 456906 Help People With Overweight or Obesity to Lose Weight

    Boehringer Ingelheim2021NCT04667377

    interventionalphase2completedn=387

  24. A Study to Test Safety and Efficacy of Survodutide (BI456906) in Adults With Non-alcoholic Steatohepatitis (NASH) and Fibrosis (F1-F3)

    Boehringer Ingelheim2021NCT04771273

    interventionalphase2completedn=295

Papers (17)

  1. Survodutide in adults with obesity and metabolic dysfunction-associated steatotic liver disease: SYNCHRONIZE-MASLD, a randomized, double-blind, placebo-controlled phase 3 trial.

    Kaplan LM, et al.Nature medicine2026PMID 42252333

    journal articlerandomized controlled trialclinical trial, phase iii

  2. Survodutide Once Weekly for the Treatment of Adults with Obesity.

    le Roux CW, et al.The New England journal of medicine2026PMID 42253238

    journal articlerandomized controlled trialmulticenter studyclinical trial, phase iii

  3. Novel GLP-1-based Medications for Type 2 Diabetes and Obesity.

    Son JW, et al.Endocrine reviews2026PMID 41054801

    journal articlereview

  4. Weight management treatment in obesity.

    Rubio-Herrera MA, et al.Medicina clinica2025PMID 40865172

    journal articlereview

  5. Efficacy and Safety of GLP-1 Receptor Agonists, Dual Agonists, and Retatrutide for Weight Loss in Adults With Overweight or Obesity: A Bayesian NMA.

    Sinha B, et al.Obesity (Silver Spring, Md.)2025PMID 40685589

    journal articlenetwork meta-analysissystematic review

  6. Therapeutic horizons in metabolic dysfunction-associated steatohepatitis.

    Newsome PN, et al.The Journal of clinical investigation2025PMID 40590228

    journal articlereviewresearch support, n.i.h., extramuralresearch support, non-u.s. gov't

  7. Emerging pharmacotherapies for obesity: A systematic review.

    Kokkorakis M, et al.Pharmacological reviews2025PMID 39952695

    journal articlesystematic review

  8. Comparison of pharmacological therapies in metabolic dysfunction-associated steatohepatitis for fibrosis regression and MASH resolution: Systematic review and network meta-analysis.

    Souza M, et al.Hepatology (Baltimore, Md.)2025PMID 39903735

    journal articlesystematic reviewcomparative studynetwork meta-analysis

  9. The impact of weight loss on fat-free mass, muscle, bone and hematopoiesis health: Implications for emerging pharmacotherapies aiming at fat reduction and lean mass preservation.

    Stefanakis K, et al.Metabolism: clinical and experimental2024PMID 39481534

    journal articlereview

  10. Glucagon and GLP-1 receptor dual agonist survodutide for obesity: a randomised, double-blind, placebo-controlled, dose-finding phase 2 trial.

    le Roux CW, et al.The lancet. Diabetes & endocrinology2024PMID 38330987

    clinical trial, phase iijournal articlemulticenter studyrandomized controlled trialresearch support, non-u.s. gov't

  11. GLP-1, GIP/GLP-1, and GCGR/GLP-1 receptor agonists: Novel therapeutic agents for metabolic dysfunction-associated steatohepatitis.

    Singh A, et al.World journal of gastroenterology2024PMID 39735270

    reviewjournal article

  12. Dose-response effects on HbA(1c) and bodyweight reduction of survodutide, a dual glucagon/GLP-1 receptor agonist, compared with placebo and open-label semaglutide in people with type 2 diabetes: a randomised clinical trial.

    Blüher M, et al.Diabetologia2024PMID 38095657

    randomized controlled trialmulticenter studyclinical trial, phase iijournal articleresearch support, non-u.s. gov't

  13. Efficacy and Safety of GLP-1 Medicines for Type 2 Diabetes and Obesity.

    Drucker DJDiabetes care2024PMID 38843460

    journal articlereviewresearch support, non-u.s. gov't

  14. A Phase 2 Randomized Trial of Survodutide in MASH and Fibrosis.

    Sanyal AJ, et al.The New England journal of medicine2024PMID 38847460

    journal articleclinical trial, phase iirandomized controlled trialmulticenter study

  15. Polyagonists in Type 2 Diabetes Management.

    Dissanayake HA, et al.Current diabetes reports2024PMID 38150106

    journal articlereview

  16. Survodutide for the Treatment of Obesity: Rationale and Design of the SYNCHRONIZE Cardiovascular Outcomes Trial.

    Kosiborod MN, et al.JACC. Heart failure2024PMID 39453356

    clinical trial protocoljournal articleresearch support, n.i.h., extramural

  17. BI 456906: Discovery and preclinical pharmacology of a novel GCGR/GLP-1R dual agonist with robust anti-obesity efficacy.

    Zimmermann T, et al.Molecular metabolism2022PMID 36356832

    journal articleresearch support, non-u.s. gov't

Discussion

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For Research & Educational Discussion Only. Not Medical Advice

This guide is educational reference material compiled from published literature. It is not medical advice, not a recommendation, and not a substitute for a clinician who knows your history. Nothing here should be used to make a decision about your own health without one.

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