Evidence maps
The evidence, mapped
Every trial arm, outcome trial and milestone in one place, with a source behind each number. These are cross-trial comparisons: they show direction, not head-to-head results.
Map 1
Weight loss vs side-effect toll
How much weight each dose takes off, against how many people it costs in side effects. Up and to the left is better.
GLP-1 onlyMulti-hormone (GIP or glucagon)Amylin-basedShotPillPhase 2 or earlier
15 of 25 arms plotted. 10 have no published figure for this measure, so they appear only in the table.
How to read it. On treatment counts people while they stay on the drug; everyone randomised counts all participants, including those who stopped. Minus placebo subtracts the placebo arm of the same trial; for nausea and other side effects the raw rate is kept because not every source reports placebo rates. The shaded corner marks arms better than the median on both axes. Trials differ in length, population and dose escalation, so small gaps are not meaningful.
Map 2
Every trial arm, dose by dose
Weight loss for each dose tested. The grey tick is the placebo arm of the same trial. Filters are shared with Map 1.
Retatrutide 12 mgTRIUMPH-1 · 80 wk
28.3%
Retatrutide 9 mgTRIUMPH-1 · 80 wk
25.9%
CagriSema 2.4/2.4 mgREDEFINE 1 · 68 wk
22.7%
Tirzepatide 15 mgSURMOUNT-1 · 72 wk
22.5%
Amycretin 20 mgPhase 1b/2a · 36 wk · estimand n/s
22.0%
Tirzepatide 10 mgSURMOUNT-1 · 72 wk
21.4%
Semaglutide 7.2 mgSTEP UP · 72 wk
20.7%
Eloralintide 9 mgPhase 2 · 48 wk
20.1%
MariTide up to 420 mg monthlyPhase 2 · 52 wk · estimand n/s
20.0%
Retatrutide 4 mgTRIUMPH-1 · 80 wk
19.0%
Eloralintide 6 mgPhase 2 · 48 wk
17.6%
Semaglutide 2.4 mgSTEP 1 · 68 wk
16.9%
Oral semaglutide 25 mg pillOASIS 4 · 64 wk
16.6%
Survodutide 3.6 or 6 mgSYNCHRONIZE-1 · 76 wk · estimand n/s
16.6%
Tirzepatide 5 mgSURMOUNT-1 · 72 wk
16.0%
Mazdutide 6 mgGLORY-1 · 48 wk
14.8%
VK2735 up to 15 mgVENTURE · 13 wk · estimand n/s
14.7%
Orforglipron 36 mg pillATTAIN-1 · 72 wk
12.4%
Eloralintide 3 mgPhase 2 · 48 wk
12.4%
Mazdutide 4 mgGLORY-1 · 48 wk
12.1%
Petrelintide up to 9 mgZUPREME-1 · 42 wk · estimand n/s
10.7%
Eloralintide 1 mgPhase 2 · 48 wk
9.5%
Orforglipron 12 mg pillATTAIN-1 · 72 wk
9.3%
Orforglipron 6 mg pillATTAIN-1 · 72 wk
7.8%
Liraglutide 3.0 mgSCALE · 56 wk
n/r
GLP-1 onlyMulti-hormone (GIP or glucagon)Amylin-basedShotPillPhase 2 or earlier
Map 3
Heart, kidney and outcome trials
Hazard ratios from the large outcome trials. Left of 1 means fewer events on the drug. Diamonds are trials against another active drug, not placebo.
Trial · drug← Favours drugFavours comparator →Hazard ratio
ELIXALixisenatide vs placebo · 2015Heart attack, stroke, CV death · n=6,068
1.0295% CI 0.89–1.17
LEADERLiraglutide vs placebo · 2016Heart attack, stroke, CV death · n=9,340
0.8795% CI 0.78–0.97
SUSTAIN-6Semaglutide (diabetes dose) vs placebo · 2016Heart attack, stroke, CV death · n=3,297
0.7495% CI 0.58–0.95
EXSCELExenatide weekly vs placebo · 2017Heart attack, stroke, CV death · n=14,752
0.9195% CI 0.83–1.00
HARMONY OutcomesAlbiglutide vs placebo · 2018Heart attack, stroke, CV death · n=9,463
0.7895% CI 0.68–0.90
REWINDDulaglutide vs placebo · 2019Heart attack, stroke, CV death · n=9,901
0.8895% CI 0.79–0.99
PIONEER 6Oral semaglutide vs placebo · 2019Heart attack, stroke, CV death · n=3,183
0.7995% CI 0.57–1.11
AMPLITUDE-OEfpeglenatide vs placebo · 2021Heart attack, stroke, CV death · n=4,076
0.7395% CI 0.58–0.92
SELECTSemaglutide 2.4 mg vs placebo · 2023Heart attack, stroke, CV death · n=17,604
0.8095% CI 0.72–0.90
FLOWSemaglutide 1.0 mg vs placebo · 2024Kidney disease · n=3,533
0.7695% CI 0.66–0.88
SURPASS-CVOTTirzepatide vs dulaglutide (active) · 2025Heart attack, stroke, CV death · n=13,165
0.9295.3% CI 0.83–1.01
ACHIEVE-4Orforglipron vs insulin glargine (active) · 2026Heart attack, stroke, CV death · n=2,749
0.8495% CI 0.59–1.20
0.40.60.811.2
GLP-1 onlyMulti-hormone (GIP or glucagon)Amylin-basedActive comparator
Outcome trials still running or awaiting results
SURMOUNT-MMOTirzepatide
Heart attack, stroke and death in people with obesity, no diabetes
Heart attack, stroke and death in people with obesity, no diabetes
REDEFINE 3CagriSema
Cardiovascular outcomes in people with CV disease
Cardiovascular outcomes in people with CV disease
SYNCHRONIZE-CVOTSurvodutide
Cardiovascular safety and outcomes; results not yet public
Cardiovascular safety and outcomes; results not yet public
Older diabetes outcome trials (ELIXA to AMPLITUDE-O) are shown with the hazard ratios from their primary publications, as pooled in the meta-analysis below. The populations differ: most are people with type 2 diabetes, SELECT is people with obesity and no diabetes, and SUMMIT is people with heart failure.
Map 4
Timeline: results, approvals and what is next
Filled marks have happened; hollow marks are expected and based on company guidance or our estimates.
2028
Jan 2028Retatrutide · FDA decision
Earliest likely US approval of retatrutide (our estimate)
Earliest likely US approval of retatrutide (our estimate)
2027
Sep 2027VK2735 · Trial result
VANQUISH Phase 3 trials complete (estimate)
VANQUISH Phase 3 trials complete (estimate)
Jun 2027MariTide · Trial result
First MariTide Phase 3 (MARITIME) readouts (estimate)
First MariTide Phase 3 (MARITIME) readouts (estimate)
Feb 2027Retatrutide · Filing
Retatrutide submitted to the FDA (company guidance)
Retatrutide submitted to the FDA (company guidance)
2026
Dec 2026Eloralintide · Trial start
Eloralintide + tirzepatide Phase 3 starts
Eloralintide + tirzepatide Phase 3 starts
Dec 2026Petrelintide · Trial start
Petrelintide Phase 3 program starts
Petrelintide Phase 3 program starts
Dec 2026VK2735 · Trial start
Oral VK2735 Phase 3 program starts
Oral VK2735 Phase 3 program starts
Nov 2026CagriSema · FDA decision
FDA decision on CagriSema expected
FDA decision on CagriSema expected
Sep 2026Petrelintide · Trial result
ZUPREME-1 in The Lancet: up to 10.7% at 42 weeks
ZUPREME-1 in The Lancet: up to 10.7% at 42 weeks
Jul 2026Retatrutide · Trial result
TRIUMPH-2 and TRIUMPH-3 read out
TRIUMPH-2 and TRIUMPH-3 read out
Jun 2026Survodutide · Trial result
SYNCHRONIZE-1 published: 16.6% weight loss
SYNCHRONIZE-1 published: 16.6% weight loss
May 2026Retatrutide · Trial result
TRIUMPH-1 topline: 28.3% weight loss at 80 weeks
TRIUMPH-1 topline: 28.3% weight loss at 80 weeks
Apr 2026Orforglipron · Trial result
ACHIEVE-4: CV safety met against insulin glargine
ACHIEVE-4: CV safety met against insulin glargine
Apr 2026Orforglipron · Approval
FDA approves Foundayo, the first small-molecule GLP-1 pill
FDA approves Foundayo, the first small-molecule GLP-1 pill
Mar 2026Semaglutide · Approval
FDA approves Wegovy HD (7.2 mg)
FDA approves Wegovy HD (7.2 mg)
Jan 2026Tirzepatide · Trial result
SURPASS-CVOT published: CV protection at least as good as dulaglutide
SURPASS-CVOT published: CV protection at least as good as dulaglutide
2025
Dec 2025Semaglutide · Approval
FDA approves the Wegovy pill (oral semaglutide 25 mg)
FDA approves the Wegovy pill (oral semaglutide 25 mg)
Aug 2025Orforglipron · Trial result
ATTAIN-1 topline: 12.4% weight loss on the top dose
ATTAIN-1 topline: 12.4% weight loss on the top dose
Jun 2025Mazdutide · Approval
Mazdutide approved in China
Mazdutide approved in China
Jun 2025CagriSema · Trial result
REDEFINE 1 published: 22.7% weight loss at 68 weeks
REDEFINE 1 published: 22.7% weight loss at 68 weeks
Mar 2025Semaglutide · Trial result
SOUL: oral semaglutide cuts CV events by 14%
SOUL: oral semaglutide cuts CV events by 14%
2024
Nov 2024Tirzepatide · Trial result
SUMMIT: 38% fewer heart failure events or CV deaths in HFpEF
SUMMIT: 38% fewer heart failure events or CV deaths in HFpEF
May 2024Semaglutide · Trial result
FLOW: 24% lower risk of major kidney events
FLOW: 24% lower risk of major kidney events
2023
Nov 2023Tirzepatide · Approval
FDA approves Zepbound for weight management
FDA approves Zepbound for weight management
Nov 2023Semaglutide · Trial result
SELECT: 20% fewer heart attacks, strokes and CV deaths
SELECT: 20% fewer heart attacks, strokes and CV deaths
2022
Apr 2022Tirzepatide · Trial result
SURMOUNT-1 topline: up to 22.5% weight loss
SURMOUNT-1 topline: up to 22.5% weight loss
2021
Jun 2021Semaglutide · Approval
FDA approves Wegovy for weight management
FDA approves Wegovy for weight management
Feb 2021Semaglutide · Trial result
STEP 1 published: 14.9% weight loss at 68 weeks
STEP 1 published: 14.9% weight loss at 68 weeks
GLP-1 onlyMulti-hormone (GIP or glucagon)Amylin-basedTrial resultApprovalFiling or trial startFDA decision
Sources for these maps
- Eli Lilly: SURMOUNT-1 topline results by dose
- Wilding et al., NEJM 2021 (STEP 1)
- FDA approves Wegovy HD, HCPLive, Mar 2026
- Wharton et al., NEJM 2025 (OASIS 4)
- Eli Lilly: ATTAIN-1 topline results
- Pi-Sunyer et al., NEJM 2015 (SCALE)
- Innovent: GLORY-1 published in NEJM (per-dose results)
- Novo Nordisk: REDEFINE 1 published in NEJM
- Eli Lilly: TRIUMPH-1 topline results
- Fierce Biotech: SYNCHRONIZE-1 at ADA 2026
- HCPLive: MariTide Phase 2
- Healio: eloralintide Phase 2
- Pharmacy Times: ZUPREME-1 results
- Fierce Biotech: amycretin full data
- Viking Therapeutics: Q2 2026 update
- Sattar et al., GLP-1 outcome trials meta-analysis (preprint)
- ACC summary: SELECT (semaglutide, overweight or obesity)
- ACC summary: FLOW (semaglutide, kidney disease)
- ACC summary: SUMMIT (tirzepatide, HFpEF)
- ACC summary: SOUL (oral semaglutide)
- ACC journal scan: SURPASS-CVOT
- Eli Lilly: ACHIEVE-4 results
- PharmExec: TRIUMPH-2 and TRIUMPH-3