What Is Survodutide? Glucagon/GLP-1 Dual Agonist, Results and Status

Key facts

Survodutide (BI 456906) is an investigational glucagon receptor and GLP-1 receptor dual agonist, licensed to Boehringer Ingelheim from Zealand Pharma and given once weekly by injection in trials.^[1]^[12]
In a 46-week phase 2 trial, weight fell by up to 14.9% at 4.8 mg against 2.8% on placebo.^[10]
In phase 3 SYNCHRONIZE-1, people without diabetes lost up to 16.6% at 76 weeks had everyone stayed on treatment (3.2% on placebo), or 12.2% to 13.0% on the treatment-regimen estimand.^[1]^[13]
In a 48-week MASH trial, up to 62% had MASH improve with no worsening of fibrosis, against 14% on placebo.^[11]
It is not approved anywhere as of November 2026. Results of the 5,530-person SYNCHRONIZE-CVOT trial are still to come.^[3]^[17]

What Is Survodutide?

Survodutide is a once-weekly injectable peptide that activates both the glucagon and GLP-1 receptors, tested at doses up to 6.0 mg in its phase 3 SYNCHRONIZE trials for obesity.^[1]^[12]

Survodutide at a glance, November 2026.
Feature	Survodutide
Developer	Boehringer Ingelheim, licensed from Zealand Pharma^[1]
Development code	BI 456906^[1]
Drug class	Glucagon receptor and GLP-1 receptor dual agonist^[1]
Structure	29-amino-acid peptide based on a modified glucagon sequence, with a C18 fatty diacid on a linker at position 24^[6]
Receptor balance	About 1:8 (glucagon : GLP-1 receptor) in human plasma^[6]
Dosing in trials	Once weekly, subcutaneous^[12]
Doses studied	0.6 mg to 6.0 mg weekly, plus 2.4 mg twice weekly in one phase 1 study^[10]^[11]^[9]
Best phase 2 result	-14.9% at 46 wk (4.8 mg)^[10]
Best phase 3 result	Up to -16.6% at 76 wk (efficacy estimand)^[1]
Other target	MASH (fatty liver disease with inflammation)^[11]
Status	Investigational; not approved^[3]

Boehringer Ingelheim is solely responsible for developing and commercialising survodutide worldwide. Zealand Pharma is eligible for high single to low double-digit percentage royalties on sales and up to EUR 315 million in outstanding milestone payments.^[4] Survodutide is not sold in this shop. This page summarises published research for reference.

How Survodutide Works

Survodutide activates the GLP-1 receptor to cut appetite and the glucagon receptor to act on the liver, with a receptor ratio of about 1:8 in human plasma, similar to the earlier dual agonist cotadutide.^[1]^[6]

It is built on glucagon. Boehringer modified the human glucagon sequence, added the unnatural amino acid Ac4c at position 2 to resist breakdown by DPP-4, and attached a C18 fatty diacid that binds albumin so the drug lasts long enough for weekly dosing.^[6]
GLP-1 drives the appetite effect. Boehringer says the GLP-1 action decreases appetite and increases fullness.^[1] In mice, a glucagon-only agonist did not reduce food intake, consistent with the intake effect depending on the GLP-1 receptor.^[7]
Glucagon targets the liver. The glucagon action is thought to act directly on the liver to reduce liver fat and regulate metabolism.^[1]
It burns more energy in animals. In mice, survodutide gave more weight loss than maximally effective doses of semaglutide, through both higher energy expenditure and lower food intake.^[6]
It reaches appetite centres from the blood. In mice it entered circumventricular organs and nearby hypothalamic and hindbrain areas without uniformly crossing the blood-brain barrier.^[7]

Lilly’s retatrutide adds a third receptor, GIP, to the same glucagon and GLP-1 pair.^[18] For how retatrutide compares with an amylin approach, see eloralintide vs retatrutide.

Survodutide Phase 2 Weight Loss Results (46 Weeks)

In the 46-week phase 2 trial of 386 treated adults without diabetes, survodutide cut body weight by 6.2% to 14.9% depending on dose, against 2.8% on placebo.^[10]

Phase 2: mean weight change at 46 weeks

Planned-treatment analysis, as reported in the Lancet Diabetes & Endocrinology abstract. 20 weeks of dose escalation, then 26 weeks at dose.

The trial ran at 43 centres in 12 countries and enrolled adults aged 18 to 75 with a BMI of 27 or more.^[10]
Only 60.4% of participants completed the 46 weeks (61% on survodutide, 60% on placebo).^[10]
Weight loss rose with dose, and the authors concluded all tested doses were tolerated.^[10]
In earlier phase 1 work, placebo-corrected weight loss reached 13.8% after 16 weeks of rising doses.^[8]

Survodutide and MASH (Liver Phase 2)

In a 48-week phase 2 trial of 293 adults with biopsy-confirmed MASH and fibrosis stage F1 to F3, MASH improved without fibrosis worsening in 47% to 62% on survodutide against 14% on placebo.^[11]

Phase 2 MASH trial, week 48. Liver biopsy and liver fat endpoints.
Endpoint	2.4 mg	4.8 mg	6.0 mg	Placebo
MASH improved, fibrosis not worse	47%	62%	43%	14%
Liver fat down by 30% or more	63%	67%	57%	14%
Fibrosis improved by 1 stage or more	34%	36%	34%	22%

The trial used 24 weeks of rapid dose escalation followed by 24 weeks of maintenance.^[11] In the phase 3 SYNCHRONIZE-MASLD trial (216 adults, 48 weeks, 6.0 mg), 84.2% on survodutide cut liver fat by at least 30% against 24.3% on placebo, had everyone stayed on treatment (68.5% vs 28.6% on the treatment-regimen estimand).^[15] Liver fat returned to normal (under 5%) in 61.0% against 5.7%.^[2]

The FDA gave survodutide Fast Track status in May 2021 and Breakthrough Therapy designation in September 2024 for non-cirrhotic MASH with fibrosis stage F2 or F3, and the EMA accepted it into its PRIME scheme in November 2023.^[3] Two phase 3 liver trials are running: LIVERAGE (about 1,800 adults, F2 to F3) and LIVERAGE-Cirrhosis (about 1,590 adults, compensated cirrhosis).^[1]

Survodutide Doses in Trials

Survodutide has been tested at once-weekly doses from 0.6 mg to 6.0 mg, and the phase 3 obesity trials escalate to 3.6 mg or 6.0 mg.^[10]^[12]

Trial protocols as reported in the publications. Not dosing advice.
Trial	Doses (once weekly unless noted)	Escalation as reported	Length
Phase 1, Japanese men (n = 36)	Up to 1.8 mg or 4.8 mg weekly, or 2.4 mg twice weekly	Escalated over 16 weeks^[9]	16 weeks
Phase 2 obesity (n = 386)	0.6, 2.4, 3.6 or 4.8 mg	20 weeks escalation, 26 weeks maintenance^[10]	46 weeks
Phase 2 MASH (n = 293)	2.4, 4.8 or 6.0 mg	24 weeks rapid escalation, 24 weeks maintenance^[11]	48 weeks
SYNCHRONIZE-1 and -2	Up to 3.6 mg or 6.0 mg	Uptitrated, with dose flexibility permitted^[12]	76 weeks
SYNCHRONIZE-MASLD (n = 216)	6.0 mg	Not detailed in the abstract^[15]	48 weeks
SYNCHRONIZE-CN (n = 306)	3.6 mg or 4.8 mg	Not detailed in the abstract^[16]	76 weeks
LIVERAGE trials	Up to a maximum of 6 mg	Not detailed^[1]	Ongoing

Boehringer says discontinuations in SYNCHRONIZE-2 mostly happened during escalation, because the protocol allowed limited flexibility, and that current and upcoming trials allow more flexible titration.^[3]

This section reports doses studied in clinical trials. It is not dosing advice, and survodutide is not approved for any use.

Survodutide Side Effects

Gastrointestinal effects are the most common side effects of survodutide: they affected 80.9% to 89.7% of people in SYNCHRONIZE-1 against 47.9% on placebo, and 19% stopped treatment because of them (placebo 2.9%).^[13]^[2]

Gastrointestinal adverse events by trial. Separate trials, not directly comparable.
Trial	Survodutide	Placebo	Stopped due to GI events
Phase 2 obesity, 46 wk	75% (all doses)	42%	Not reported in the abstract^[10]
SYNCHRONIZE-1, 76 wk	80.9% (3.6 mg), 89.7% (6.0 mg)	47.9%	19% vs 2.9%^[13]^[2]
SYNCHRONIZE-2, 76 wk (type 2 diabetes)	72.8% (3.6 mg), 77.7% (6.0 mg)	38.6%	18% vs 1.2%^[14]^[3]

In the phase 2 MASH trial, nausea affected 66% on survodutide vs 23% on placebo, diarrhoea 49% vs 23% and vomiting 41% vs 4%. Serious adverse events were similar (8% vs 7%).^[11]
The GI events in phase 3 were typically mild to moderate and most common during dose escalation, with nausea, vomiting, diarrhoea and constipation the most frequent.^[13]^[3]
In a phase 1 multiple-dose study, 12.5% stopped survodutide in Part A, most often for a cardiac or vascular adverse event (7.5%).^[8]
In the Japanese phase 1 study, 37.0% withdrew from escalation because of adverse events, mostly decreased appetite.^[9]
No deaths were reported in SYNCHRONIZE-1.^[13]

SYNCHRONIZE Phase 3 Results and Approval Status as of Nov 2026

Three SYNCHRONIZE phase 3 trials have reported, with up to 16.6% weight loss at 76 weeks in people without diabetes, but survodutide is not approved anywhere and the cardiovascular outcomes trial has not yet reported.^[1]^[3]

Mean weight change. Treatment-regimen estimand (regardless of stopping) and efficacy estimand (had everyone stayed on treatment).
Trial	Population	Length	Survodutide	Placebo
SYNCHRONIZE-1 (n = 725)	Obesity or overweight, no diabetes	76 wk	-12.2% (3.6 mg), -13.0% (6.0 mg); up to -16.6% efficacy	-5.4%; -3.2% efficacy^[13]^[1]
SYNCHRONIZE-2 (n = 752)	Obesity or overweight with type 2 diabetes	76 wk	-8.2% (3.6 mg), -9.8% (6.0 mg); up to -13.1% efficacy	-3.9%; -3.1% efficacy^[14]^[3]
SYNCHRONIZE-MASLD (n = 216)	Obesity with at-risk fatty liver disease	48 wk	-8.7% (6.0 mg); -12.2% efficacy	-1.4%; -1.0% efficacy^[15]

In SYNCHRONIZE-1, up to 85.1% lost at least 5% of body weight (placebo 38.8%), and average loss reached up to 17.8 kg (39.2 lb), both on the efficacy estimand.^[1]
An MRI substudy of SYNCHRONIZE-1 found up to 34.0% less visceral fat and 63.1% less liver fat, with lean mass no more than 11.3% of the tissue lost at the highest dose.^[2] Zealand noted the lean figure was revised up from 10.8% after recalculation.^[5]
In SYNCHRONIZE-2, HbA1c fell by 0.9 and 0.8 points from a baseline of 7.4% (placebo 0.2), and by up to 1.21 points on the efficacy estimand.^[14]^[3]
SYNCHRONIZE-CVOT enrolled 5,530 people and reached primary completion in June 2026; Boehringer said in October 2026 that results would come later in the year.^[17]^[3]

Boehringer’s release of 1 October 2026 states that survodutide has not been approved for use and that its efficacy and safety have not been established.^[3] None of the Boehringer or Zealand releases reviewed for this guide, up to 8 November 2026, announce a regulatory submission for obesity or MASH.

Survodutide vs Eloralintide

Survodutide reached 14.9% weight loss at 46 weeks in phase 2, against 20.1% at 48 weeks for Lilly’s eloralintide, but they act on different hormone systems and no head-to-head trial exists.^[10]^[19]

Separate trials with different designs and estimands. Not directly comparable.
Feature	Survodutide	Eloralintide
Developer	Boehringer Ingelheim (from Zealand Pharma)^[1]	Eli Lilly^[19]
Code	BI 456906^[1]	LY3841136^[19]
Target	Glucagon and GLP-1 receptors^[1]	Amylin receptors, about 12 times more potent at AMY1 than at the calcitonin receptor^[21]
Half-life extension	C18 fatty diacid^[6]	C20 fatty diacid^[21]
Doses in phase 2	0.6 to 4.8 mg weekly^[10]	1 to 9 mg weekly^[20]
Best phase 2 weight loss	-14.9% at 46 wk (4.8 mg)^[10]	-20.1% at 48 wk (9 mg)^[19]
Phase 3	SYNCHRONIZE: 3 trials reported, CVOT pending^[3]	ENLIGHTEN: running, primary completion from 2028^[22]
Status	Not approved^[3]	Not approved^[19]

The two drugs come at weight loss from different angles: survodutide pairs GLP-1 appetite control with glucagon action on the liver, while eloralintide copies amylin, a hormone released with insulin.^[1]^[21] For the full eloralintide profile see what is eloralintide, and for other approaches see GLP-1 alternatives.

There is also no head-to-head trial of survodutide against tirzepatide or semaglutide. For context only, tirzepatide 15 mg gave 20.9% weight loss at 72 weeks in SURMOUNT-1, a separate trial with a different design.^[23]

Frequently Asked Questions

What is survodutide?

Survodutide (BI 456906) is an investigational once-weekly injection that activates both the glucagon and GLP-1 receptors. Boehringer Ingelheim is developing it, under licence from Zealand Pharma, for obesity and the fatty liver disease MASH.

Is survodutide FDA approved?

No. As of November 2026 survodutide is not approved by the FDA or any other regulator. It holds FDA Breakthrough Therapy designation for MASH with moderate or advanced fibrosis, and the cardiovascular outcomes trial SYNCHRONIZE-CVOT has not yet reported.

How much weight loss with survodutide?

In SYNCHRONIZE-1, people without diabetes lost 12.2% (3.6 mg) and 13.0% (6.0 mg) at 76 weeks on the treatment-regimen estimand, and up to 16.6% had everyone stayed on treatment, against 5.4% and 3.2% on placebo. People with type 2 diabetes lost less, up to 13.1% on the efficacy estimand.

Survodutide vs tirzepatide: which is better?

No head-to-head trial has compared them, so there is no direct answer. In separate trials, tirzepatide 15 mg gave 20.9% weight loss at 72 weeks in SURMOUNT-1 and survodutide gave up to 16.6% at 76 weeks in SYNCHRONIZE-1, but the trials differ in design, populations and estimands.

What are the side effects of survodutide?

Mostly gastrointestinal: nausea, vomiting, diarrhoea and constipation, usually mild to moderate and most common during dose escalation. In SYNCHRONIZE-1, GI events affected 80.9% to 89.7% on survodutide vs 47.9% on placebo, and 19% stopped treatment because of them.

What doses of survodutide were used in trials?

Trials have tested once-weekly doses from 0.6 mg to 6.0 mg. The phase 3 SYNCHRONIZE obesity trials escalate to 3.6 mg or 6.0 mg. There is no approved dose; this is trial data, not advice.

Sources

For research use only. Not for human or veterinary consumption. This guide summarises published research for information only. It is not medical advice and does not describe any use of products sold on this site.

What Is Survodutide? Boehringer Ingelheim’s Glucagon and GLP-1 Dual Agonist