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Investigational peptide drugHuman trialsIn clinical trials

Survodutide

Survodutide

Last reviewed October 27, 2026 · 18 sources · Written for general readers · Compare with another compound →

The bottom line

Survodutide is an experimental weekly shot that acts on glucagon and GLP-1 receptors. In a 76 week trial, weight fell about 12% to 13% counting everyone, and up to about 17% in people who stayed on it, and it cut liver fat sharply. But stomach side effects hit more than 8 in 10 people, nearly 1 in 5 quit because of them, and it is not approved anywhere.

Where the evidence stands

What it is

Survodutide is an experimental weekly shot from Boehringer Ingelheim. It acts on two receptors, glucagon and GLP-1, so it is called a dual agonist.[1] In early research it was called BI 456906.[2]

It is not approved anywhere. FDA gave it Fast Track and Breakthrough Therapy status for MASH, a serious fatty liver disease. These speed up development and review but are not approvals.[1]

PubChem lists its formula as C192H289N47O61 and its CAS number as 2805997-46-8.[3]

Name
Survodutide (Survodutide)
Other names
BI 456906
Type
Investigational peptide drug
CAS number
2805997-46-8
Formula
C192H289N47O61
Molecular weight
About 4232 g/mol

What it does in the body

Survodutide is a lab made peptide that switches on two hormone receptors at once: the GLP-1 receptor, which signals fullness and helps control blood sugar, and the glucagon receptor, which acts mainly on the liver.[1][2] It does not occur in nature; it was designed to combine the appetite effects of GLP-1 drugs with glucagon's effects on liver fat.[1]

This is the biology, area by area. A change measured in the body, like a higher blood level, does not always mean a person feels a benefit. The claims check below covers that.

Fat and appetite

Measured in people

In SYNCHRONIZE-1, 725 adults without diabetes lost 12.2% to 13.0% of their weight over 76 weeks counting everyone, versus 5.4% on placebo.[4] In people who stayed on treatment, losses reached 16.6%, and a body scan substudy found belly organ fat fell by up to 34%.[5]

Liver

Measured in people

In SYNCHRONIZE-MASLD, 216 adults with fatty liver disease were treated for 48 weeks. Counting everyone, 68.5% had liver fat drop by at least 30% versus 28.6% on placebo.[6] In a 293 person MASH trial, a reanalysis estimated that weight loss explained about two thirds of the improvement in liver inflammation but only about a third of the improvement in scarring, which hints at a direct liver effect of the glucagon part.[7][8]

Blood sugar

Measured in people

In 413 adults with type 2 diabetes over 16 weeks, markers of insulin making cell function rose quickly, while insulin resistance, glucagon and fasting sugar fell. Weight loss explained much of the drop in insulin resistance but not the other changes.[9] Over 76 weeks in SYNCHRONIZE-2, HbA1c (a three month blood sugar average) fell 0.8 to 0.9 points versus 0.2 on placebo.[10]

Brain and appetite

Seen in animals

In mice, glowing labeled survodutide reached brain areas with a leaky blood brain barrier and switched on fullness centers, and its effect on food intake depended on the GLP-1 receptor. Glucagon receptors were barely found in these areas, and a glucagon only drug lowered weight without curbing eating.[11]

Energy use

Seen in animals

In obese mice, survodutide raised the energy the body burns in addition to cutting food intake, which led to more weight loss than semaglutide.[2] This has not been shown in people.

Kidneys

Seen in animals

In diabetic mice with severe kidney disease, ten weeks of daily survodutide shots lowered protein leaking into the urine, kidney inflammation and swelling of the kidney filters.[12] No human kidney outcome results have been reported.

How it works

Survodutide switches on both the GLP-1 receptor and the glucagon receptor.[1]

  • The GLP-1 part lowers appetite and helps control blood sugar, like other GLP-1 drugs.[1]
  • The glucagon part acts mainly on the liver. In mice, the two actions together cut food intake and raised the energy the body burns.[2]
  • The maker says the combination is designed to lower appetite, improve blood sugar and reduce liver fat.[1]

The extra energy burning is shown in mice. In people, the clearest effects are less eating, weight loss and less liver fat.

What the research shows

We keep animal and human evidence apart. A result in animals is a reason to study something in people, not proof that it works in people.

Animal and lab studies

Mouse studies showed more weight loss than semaglutide

  • In obese mice, survodutide led to greater weight loss than the most effective doses of semaglutide.[2]
  • The extra weight loss came from eating less and from higher energy use.[2]
  • Liver markers showed the glucagon receptor was being switched on, while tests of blood sugar, food intake and stomach emptying showed GLP-1 activity.[2]
  • Studies in mice bred without the GLP-1 receptor helped confirm that it acts on both receptors.[2]
  • In mice, survodutide reached and switched on brain fullness areas next to leaky parts of the blood brain barrier, and its effect on eating depended on the GLP-1 receptor. A glucagon only drug lowered weight without reducing food intake.[11]
  • In diabetic mice with high blood pressure driven kidney disease, ten weeks of treatment lowered urine protein, blood sugar and kidney inflammation and improved the kidney filters.[12]

Limit: Mouse energy burning results have not been shown in people.

Human studies

Large trials show strong weight and liver results, with high quit rates

  • Phase 2 obesity trial: 387 adults without diabetes got weekly shots or placebo for 46 weeks. Among those who stayed on treatment, weight fell 6.2% to 14.9% depending on strength versus 2.8% on placebo. Only about 60% finished the full treatment period, often because the dose was raised quickly.[13]
  • Phase 2 diabetes trial: 413 adults with type 2 diabetes were treated for 16 weeks. HbA1c fell by up to about 1.7 points, and weight fell by up to 8.7%. Side effects, mainly gut problems, were reported by 78% on survodutide versus 53% on placebo.[14]
  • Phase 2 MASH trial: 293 adults with biopsy proven MASH and liver scarring were treated for 48 weeks. Liver inflammation improved in up to 62% versus 14% on placebo, and liver fat fell by at least 30% in up to 67% versus 14%.[7]
  • SYNCHRONIZE-1: 725 adults with obesity or overweight and no diabetes were treated for 76 weeks. Counting everyone, weight fell 12.2% to 13.0% versus 5.4% on placebo, and 72% to 73% lost at least 5% versus 46%. Gut side effects, mostly mild to moderate, hit 80.9% to 89.7% versus 47.9%.[4] In people who stayed on treatment as planned, the company reported up to 16.6% versus 3.2%.[5]
  • SYNCHRONIZE-2: 752 adults with type 2 diabetes and excess weight were treated for 76 weeks. Counting everyone, weight fell 8.2% to 9.8% versus 3.9% on placebo, and HbA1c fell 0.8 to 0.9 points versus 0.2. Gut side effects hit 72.8% to 77.7% versus 38.6%.[10] Among people who stayed on treatment, the company reported up to 13.1% versus 3.1%.[1]
  • SYNCHRONIZE-MASLD: 216 adults with obesity and fatty liver disease in the US and Spain were treated for 48 weeks. Counting everyone, 68.5% had at least a 30% drop in liver fat versus 28.6% on placebo, and weight fell 8.7% versus 1.4%.[6] Among those who stayed on treatment, the rates were 84.2% versus 24.3%, and liver fat returned to normal in 61% versus 6%.[6][5]
  • Cirrhosis study: 41 people with liver cirrhosis, some with severe disease, and healthy people got single shots, and another 41 got weekly shots for 28 weeks without a placebo group. Drug levels were similar with and without cirrhosis. Liver fat, stiffness and size and body weight generally fell, and drug related side effects were reported by 82% to 88% in the weekly groups.[15]
  • Blood sugar markers: a reanalysis of 413 adults with type 2 diabetes and 387 adults with obesity found improved insulin making cell function and insulin sensitivity, only partly explained by weight loss.[9]
  • Liver mediation analysis: in 170 people from the MASH trial with paired biopsies, weight loss accounted for about 67% of the effect on clearing MASH but only about 36% of the effect on scarring.[8]
  • Quitting: in the phase 3 obesity and diabetes trials, 18% to 19% stopped because of gut side effects, versus about 1% to 3% on placebo.[5][1]

Limit: A heart safety trial of 5,531 adults finished in June 2026 but had not reported results by October 2026, and we found no data on what happens to weight after stopping.[16]

Claims check

The most common claims about this compound, and what studies actually found. Verdicts rate the evidence, not whether you should use it.

Causes large weight loss

Shown in people

SYNCHRONIZE-1 treated 725 adults with obesity or overweight and no diabetes for 76 weeks. Counting everyone, including people who stopped, weight fell 12.2% to 13.0% versus 5.4% on placebo.[4] Among people who stayed on treatment as planned, weight fell by up to 16.6% versus 3.2%.[5] An earlier 46 week trial in 387 adults found up to 14.9% loss versus 2.8% on placebo.[13]

Clears fat from the liver

Shown in people

In a 48 week trial of 293 adults with biopsy proven MASH, the liver inflammation improved in 43% to 62% of people on survodutide versus 14% on placebo.[7] In the 48 week SYNCHRONIZE-MASLD trial of 216 adults, 84.2% of people who stayed on treatment had their liver fat drop by at least 30%, versus 24.3% on placebo; counting everyone it was 68.5% versus 28.6%.[6]

Reverses liver scarring

Mixed results

In the 48 week MASH trial, liver scarring improved by at least one stage in about 34% to 36% on survodutide versus 22% on placebo.[7] This was a secondary result in a mid stage trial, so larger trials are under way to confirm it.[5] A reanalysis of 170 people with paired biopsies estimated that only about a third of the scarring benefit came from weight loss.[8]

Lowers blood sugar in type 2 diabetes

Shown in people

SYNCHRONIZE-2 treated 752 adults with type 2 diabetes and excess weight for 76 weeks. Counting everyone, HbA1c (a three month blood sugar average) fell 0.8 to 0.9 points from a starting level of 7.4%, versus 0.2 on placebo, and weight fell 8.2% to 9.8% versus 3.9%.[10] Among people who stayed on treatment, the company reported HbA1c drops of up to 1.21 points.[1]

Works better than semaglutide

Mixed results

In a 16 week trial of 413 adults with type 2 diabetes, the higher survodutide strengths led to more weight loss than semaglutide, up to 8.7% versus 5.3%, while blood sugar drops were similar.[14] The trial was short and semaglutide was given openly, and no large head to head trial has been reported.[14]

Boosts metabolism and burns more calories

Only in animals

In mice, survodutide cut food intake and raised energy use, which led to more weight loss than semaglutide.[2] We found no human trial that measured whether it raises calorie burning in people.[5]

Burns fat while sparing muscle

Mixed results

In a body scan substudy of SYNCHRONIZE-1, visceral (belly organ) fat fell by up to 34%, and lean tissue made up no more than about 11% of the tissue lost at the highest strength.[5] These figures come from a company release, and the full data have not been independently reviewed.[5]

Known risks and side effects

  • Stomach and gut side effects are very common. In SYNCHRONIZE-1, gut side effects hit 80.9% to 89.7% of people versus 47.9% on placebo, and in SYNCHRONIZE-2, 72.8% to 77.7% versus 38.6%.[4][10] In the MASH trial, nausea affected 66% versus 23% on placebo and vomiting 41% versus 4%.[7]
  • Many people quit. About 18% to 19% stopped because of gut side effects in phase 3 trials, versus about 1% to 3% on placebo.[5][1]
  • Unknown long term safety. Serious adverse events were similar to placebo in the MASH trial (8% versus 7%).[7] A heart safety trial of 5,531 adults finished in June 2026, but its results had not been reported by October 2026.[16][1]
  • Unregulated research products. FDA has warned companies selling survodutide labeled research use only and urges people not to buy such products because their quality is unknown.[17]
  • Banned in tested sports. WADA bans at all times any drug that has no government approval for human use.[18]

Regulatory status

Today: Survodutide is investigational and not approved by FDA or any other agency, and Boehringer has not announced a filing date.[1] FDA has warned sellers of research use only survodutide.[17]

  1. FDA granted Fast Track designation for MASH.[1]
  2. The European Medicines Agency accepted it into its PRIME support program.[1]
  3. FDA granted Breakthrough Therapy designation for MASH.[5]
  4. Boehringer reported SYNCHRONIZE-1 and SYNCHRONIZE-MASLD results.[5]
  5. Boehringer reported SYNCHRONIZE-2 results in people with type 2 diabetes.[1]

Sources

  1. Boehringer Ingelheim. New Phase III data in people with obesity and diabetes. October 1, 2026. Company press release
  2. Zimmermann T, Thomas L, Baader-Pagler T, et al. BI 456906: Discovery and preclinical pharmacology of a novel GCGR/GLP-1R dual agonist with robust anti-obesity efficacy. Mol Metab. 2022. PMID 36356832
  3. National Center for Biotechnology Information. PubChem Compound Summary for CID 168429725, Survodutide. PubChem CID 168429725
  4. le Roux CW, Wharton S, Startseva E, et al. Survodutide Once Weekly for the Treatment of Adults with Obesity. N Engl J Med. 2026;395(8):776-787. PMID 42253238
  5. Boehringer Ingelheim. Positive data from two Phase III SYNCHRONIZE obesity trials. June 7, 2026. Company press release
  6. Kaplan LM, Startseva E, le Roux CW, et al. Survodutide in adults with obesity and metabolic dysfunction-associated steatotic liver disease: SYNCHRONIZE-MASLD, a randomized, double-blind, placebo-controlled phase 3 trial. Nat Med. 2026;32(8):2948-2958. PMID 42252333
  7. Sanyal AJ, Bedossa P, Fraessdorf M, et al. A Phase 2 Randomized Trial of Survodutide in MASH and Fibrosis. N Engl J Med. 2024. PMID 38847460
  8. Noureddin M, Sanyal AJ, Bedossa P, et al. Weight reduction-dependent/-independent effects of survodutide on liver endpoints: Mediation analysis of a phase 2 trial in MASH. Hepatology. 2026. PMID 42545725
  9. Ekinci EI, Gonzalez Maldonado S, Unseld A, et al. Dual Glucagon and GLP-1 Receptor Agonist Survodutide Improves Biomarkers of Beta-Cell Function and Insulin Sensitivity in People With Type 2 Diabetes or Living With Overweight/Obesity. Diabetes Obes Metab. 2026;28(9):8242-8253. PMID 42331726
  10. Wharton S, le Roux CW, Startseva E, et al. Survodutide Once Weekly in Adults with Obesity and Type 2 Diabetes. N Engl J Med. 2026 (online ahead of print, October 1, 2026). PMID 42820639
  11. Zimmermann T, Bleymehl K, Haebel P, et al. Survodutide acts through circumventricular organs in the brain and activates neuronal regions associated with appetite regulation. Mol Metab. 2026;105:102326. PMID 41638399
  12. Hamilton A, Thisted L, Ougaard M, et al. Nephroprotective Effects of the Dual GCGR/GLP-1R Agonist Survodutide in Hypertension-Accelerated Diabetic Kidney Disease. Diabetes Obes Metab. 2026 (online ahead of print). PMID 42823075
  13. le Roux CW, Steen O, Lucas K, et al. Glucagon and GLP-1 receptor dual agonist survodutide for obesity: a randomised, double-blind, placebo-controlled, dose-finding phase 2 trial. Lancet Diabetes Endocrinol. 2024. PMID 38330987
  14. Bluher M, Rosenstock J, Hoefler J, et al. Dose-response effects on HbA1c 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. Diabetologia. 2024. PMID 38095657
  15. Lawitz E, Fraessdorf M, Neff GW, et al. Efficacy, tolerability and pharmacokinetics of survodutide, a glucagon/glucagon-like peptide-1 receptor dual agonist, in cirrhosis. J Hepatol. 2024;81(5):837-846. PMID 38857788
  16. ClinicalTrials.gov. A Study to Test the Effect of Survodutide (BI 456906) on Cardiovascular Safety in People With Overweight or Obesity (SYNCHRONIZE-CVOT). NCT06077864. NCT06077864
  17. U.S. Food and Drug Administration. FDA's Concerns with Unapproved GLP-1 Drugs Used for Weight Loss. Content current as of October 1, 2026. FDA
  18. World Anti-Doping Agency. World Anti-Doping Code International Standard: Prohibited List 2026. WADA 2026 List
Medical disclaimer

This page is educational information only. It is not medical advice and does not replace care from a licensed medical provider. Do not use this page to decide whether to take any substance. Talk to a licensed medical provider first.

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