Survodutide is an investigational once-weekly injection from Boehringer Ingelheim that activates two hormone receptors, GLP-1 and glucagon.[3] In the phase 3 SYNCHRONIZE-1 trial, weight fell 12.2% to 13.0% over 76 weeks versus 5.4% on placebo,[1] and it sharply reduced liver fat in people with fatty liver disease.[3] It is not approved anywhere but has FDA Breakthrough Therapy designation for MASH.[12]

What is survodutide?

Survodutide is designed to mimic oxyntomodulin, a gut hormone that acts on both the GLP-1 and glucagon receptors. It was licensed to Boehringer Ingelheim by Zealand Pharma.[3]

How survodutide works

  • GLP-1 action reduces appetite; in animal studies this appetite effect depended on the GLP-1 receptor.[8]
  • Glucagon action works directly on the liver, increasing fat burning, which may help clear liver fat.[3] In the phase 2 MASH trial, weight loss explained only about a third of the improvement in liver scarring, suggesting a direct liver effect.[7]

Survodutide results

Weight loss

TrialWhoSurvodutidePlacebo
SYNCHRONIZE-1 (76 weeks)725 without diabetes−12.2% to −13.0%[1]−5.4%
SYNCHRONIZE-2 (76 weeks)752 with type 2 diabetes−8.2% to −9.8%[2]−3.9%
Phase 2 (46 weeks)386 adultsup to −14.9%[4]−2.8%

The company’s analysis of people who stayed on treatment reported up to 16.6% weight loss in SYNCHRONIZE-1.[15]

SYNCHRONIZE-1 participants started at an average BMI of 37.9 and weight of 108.8 kg. About 72% on either dose lost at least 5% of their weight, versus 46.3% on placebo, and no deaths were reported.[1] Everyone in the trial also received lifestyle counseling.[1]

In the 46-week phase 2 trial, doses were raised over 20 weeks, and only about 60% of participants completed treatment.[4]

Type 2 diabetes

  • SYNCHRONIZE-2: in adults with obesity and type 2 diabetes (average starting HbA1c 7.4%), HbA1c fell 0.8 to 0.9 points versus 0.2 on placebo. Between 57.6% and 64.5% lost at least 5% of their weight, versus 35.1%.[2]
  • Phase 2 (16 weeks): in 413 adults with type 2 diabetes taking metformin, HbA1c fell by up to 1.71 points and weight by up to 8.7%. Doses of 1.8 mg or more led to more weight loss than semaglutide 1 mg (5.3%). Side effects, mainly stomach-related, affected 77.8% versus 52.5% on placebo.[6]

Fatty liver disease

  • SYNCHRONIZE-MASLD: 216 adults in the US and Spain took 6.0 mg or placebo for 48 weeks. 68.5% cut their liver fat by at least 30% versus 28.6% on placebo. Among people who stayed on treatment, the figures were 84.2% versus 24.3%, and weight fell 12.2% versus 1.0%.[3]
  • Phase 2 MASH: up to 62% had MASH improvement without worsening fibrosis versus 14% on placebo. Liver fat fell by at least 30% in 57% to 67% versus 14%, and scarring improved by at least one stage in 34% to 36% versus 22%.[5] Larger phase 3 liver trials (LIVERAGE) are under way.[18]

Ongoing survodutide phase 3 trials

  • Heart safety (SYNCHRONIZE-CVOT): 5,531 adults with overweight or obesity plus heart disease, kidney disease or at least two heart risk factors took 3.6 mg, 6.0 mg or placebo. The goal is to show no increase in heart attacks, strokes, heart failure events or heart deaths over up to 114 weeks. The trial finished in mid-2026; we found no published results as of October 2026.[20]
  • LIVERAGE: about 1,800 adults with MASH and moderate or advanced scarring (F2 to F3). A 52-week liver biopsy is the first goal, followed by liver outcomes such as cirrhosis or transplant over up to 7 years.[18]
  • LIVERAGE-Cirrhosis: about 1,590 adults with early, compensated MASH cirrhosis, tracking serious liver events over up to 4.5 years.[21]
  • Type 2 diabetes: a 600-person trial that began in August 2026 measures HbA1c at 41 weeks.[22]

Survodutide vs mazdutide and tirzepatide

Mazdutide is also a GLP-1 and glucagon dual agonist and is already approved in China. Pemvidutide is a third. Tirzepatide instead combines GLP-1 with GIP and produced more weight loss in its own trials. No head-to-head trials compare these drugs.

Survodutide side effects

  • Stomach effects: in SYNCHRONIZE-1, 80.9% to 89.7% had gastrointestinal side effects versus 47.9% on placebo.[1] In the phase 2 MASH trial, nausea occurred in 66% and vomiting in 41%.[5]
  • SYNCHRONIZE-2: stomach side effects affected 72.8% to 77.7% versus 38.6% on placebo, and were generally mild to moderate and short-lived.[2]
  • Liver trial: serious adverse events occurred in 8% on survodutide and 7% on placebo.[5]
  • Stopping treatment: in SYNCHRONIZE-2, 18% stopped because of stomach effects versus 1.2% on placebo.[14] In phase 2, 24.6% stopped due to side effects versus 3.9%.[13]
  • Heart rate rose by about 3.6 beats per minute versus 0.8 on placebo.[3]

Survodutide dosage: what has been studied

Phase 3 trials used once-weekly injections increased to 3.6 mg or 6.0 mg.[1] The authors of a phase 2 diabetes trial suggested that raising the dose more slowly could reduce stomach side effects.[6] No dose is approved, so any future dose would be set by a clinician following the label.

Questions to ask a clinician

Survodutide is available only inside clinical trials. If you are interested, ask:

  • Is there a trial near me, and do I meet its entry criteria?
  • Would an approved drug such as semaglutide or tirzepatide suit me now?
  • How would my fatty liver disease be monitored with or without treatment?

Survodutide around the world

  • Japan: an early study in Japanese men found up to 12.4% placebo-corrected weight loss in 16 weeks, though 37% withdrew during dose increases, and a Japanese phase 3 trial is under way.[9][10]
  • China: a Chinese phase 3 trial (SYNCHRONIZE-CN) is testing 3.6 and 4.8 mg.[11]
  • Russia: a 2025 Russian review describes survodutide as a next-generation dual agonist.[19]
  • Not approved in any country as of our last review.[14]
  • FDA Breakthrough Therapy designation for MASH with moderate or advanced fibrosis, and EU PRIME status.[12]
  • Not on FDA’s list of substances compounding pharmacies may use.[16]
  • Sport: unapproved drugs fall under WADA’s non-approved substances category.[17]

This is general information, not legal advice.