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Tirzepatid: što pokazuju studije

Tirzepatid je proizveo najveće prosječne gubitke tjelesne težine ikad zabilježene za neki lijek u randomiziranom ispitivanju pretilosti. Također je lijek s najzanimljivijim rezultatima koji se ne odnose na težinu.

Updated 3 min read 30 citations Evidence strength 5/5

Izlog njemačke ljekarne snimljen s ulice
muckelfloh · CC BY 3.0 · Wikimedia Commons

SURMOUNT-1: najveća veličina učinka u ovom području

SURMOUNT-1 je randomizirao odrasle osobe s pretilošću bez dijabetesa na tirzepatid 5, 10 ili 15 mg tjedno, ili placebo, tijekom 72 tjedna [8]. Prosječna promjena težine pri najvišoj dozi iznosila je oko −20,9%, dok je već doza od 5 mg iznosila oko −15% — što znači da je najniža doza tirzepatida približno odgovarala najboljem rezultatu semaglutida. Više od polovice sudionika pri višim dozama izgubilo je najmanje 20% tjelesne težine.

Nastavak tog programa produljio je praćenje i izvijestio o prevenciji dijabetesa uz održivo smanjenje težine [5], što je važno jer pomiče ishod s broja na vagi na klinički događaj.

Učinkovitost u smanjenju tjelesne težine

I ovdje vrijedi kazna dijabetesa

SURMOUNT-2 je provelo isti protokol kod odraslih osoba s pretilošću i dijabetesom tipa 2 te je pri najvišoj dozi utvrdilo prosječni gubitak težine od približno 14,7% [7]. Ponovno: velik učinak, i ponovno znatno manji nego u populaciji bez dijabetesa. Metaanaliza koja uspoređuje ova dva lijeka kod dijabetesa tipa 2 čvršće utvrđuje njihov relativni poredak [1][3].

Tirzepatid — prosječna promjena tjelesne težine po ispitivanju i populaciji
IspitivanjePopulacijaDozaTrajanjeProsječna promjena težine
SURMOUNT-1 [8]Pretilost, bez dijabetesa15 mg72 tjedna≈ −20,9%
SURMOUNT-1 [8]Pretilost, bez dijabetesa5 mg72 tjedna≈ −15%
SURMOUNT-2 [7]Pretilost + dijabetes tipa 215 mg72 tjedna≈ −14,7%
SURMOUNT-5 [10]Pretilost, izravna usporedba sa semaglutidom≤15 mg72 tjednaSuperiorniji od semaglutida

Izravna pobjeda nad semaglutidom

Neizravne usporedbe i kohorte iz stvarnog svijeta već su neko vrijeme upućivale na to [12], ali ispitivanje koje je to potvrdilo izravno je usporedilo dva lijeka pri dozama za pretilost u istoj populaciji, pri čemu je tirzepatid pobijedio u prosječnom gubitku težine s velikom razlikom [10]. Kod dijabetesa tipa 2, SURPASS-2 je već pokazalo superiornost nad semaglutidom 1 mg u pogledu i glikemijskih i težinskih ishoda [9].

Rezultati koji se ne odnose na težinu

Dva posebno provedena ispitivanja pomaknula su tirzepatid izvan kategorije pretilosti.

  • Opstruktivna apneja u snu. Kod odraslih osoba s umjerenim do teškim OSA-om i pretilošću, tirzepatid je značajno smanjio indeks apneje-hipopneje u odnosu na placebo [6]. To je prvi farmakološki tretman s randomiziranim dokazima za stanje koje se prije liječilo skoro isključivo CPAP-om.
  • Zatajenje srca s očuvanom ejekcijskom frakcijom. Kod HFpEF-a s pretilošću — fenotipa s vrlo malo učinkovitih tretmana — tirzepatid je poboljšao ishode u odnosu na placebo [4].
  • Kardiovaskularni događaji. Posebna usporedba s dulaglutidom izvijestila je o kardiovaskularnim ishodima kod dijabetesa tipa 2 [11], što se nadovezuje na ranije unaprijed definiranu metaanalizu koja nije pronašla signal kardiovaskularne štetnosti.

Također se spominje u europskim smjernicama o steatotičnoj bolesti jetre uz semaglutid [2].

Često postavljana pitanja

Je li Mounjaro isto što i Zepbound?
Ista molekula, različiti nazivi brenda za indikacije dijabetesa i pretilosti.
Je li tirzepatid jednostavno bolji od semaglutida?
U pogledu prosječnog gubitka težine u izravnom ispitivanju kod pretilosti, da [10]. U svemu ostalom — podnošljivosti za pojedinu osobu, cijeni, dostupnosti i specifičnom komorbiditetu koji se liječi — odgovor je individualan. Semaglutid ima veći skup podataka o kardiovaskularnim ishodima.
Uzrokuje li GIP komponenta dodatni gubitak težine?
To je očiti kandidat, ali mehanizam je zaista nerazjašnjen. Blokiranje GIP-a također uzrokuje gubitak težine u nekim modelima, što je jedan od čudnijih otvorenih problema u ovom području.
Moram li doći do doze od 15 mg?
Ne. Doza od 5 mg proizvela je prosječni gubitak od oko 15% u SURMOUNT-1 [8], usporedivo s najboljim rezultatom semaglutida. Doza se titrira prema podnošljivosti.
Namješten krevet u sobi internističkog odjela za tri pacijenta
玄史生 · CC0 · Wikimedia Commons

Povezano štivo

Dokazi na kojima se temelji ova stranica Stupčasti grafikon koji prikazuje sastav 18 publikacija citiranih na ovoj stranici po vrsti studije. 41211meta-analysis (4)randomised trial (12)review (1)other (1)
18 publikacija, 2021.–2025. Riječ je o kombinaciji koja uključuje i ispitivanja i sinteze, što je pozicija s koje je tvrdnja o uzročnosti razumna. Izvor: popis citata ove stranice, u nastavku.

References

Every citation below links to the original peer-reviewed record on PubMed or via DOI. Nothing here is a substitute for medical advice.

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  3. EASL-EASD-EASO Clinical Practice Guidelines on the management of metabolic dysfunction-associated steatotic liver disease (MASLD): Executive Summary Diabetologia · 2024 · Clinical guideline DOIPubMed 38869512Full text
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  7. Tirzepatide did not impact metabolic adaptation in people with obesity, but increased fat oxidation Ravussin E, Sanchez-Delgado G, Martin CK, et al. · Cell metabolism · 2025 · Randomised controlled trial DOIPubMed 40203836
  8. Efficacy and safety of tirzepatide in children and adolescents with type 2 diabetes (SURPASS-PEDS): a randomised, double-blind, placebo-controlled, phase 3 trial Hannon TS, Chao LC, Barrientos-Pérez M, et al. · Lancet (London, England) · 2025 · Randomised controlled trial DOIPubMed 40975112
  9. Efficacy and safety of once-weekly tirzepatide in Japanese patients with obesity disease (SURMOUNT-J): a multicentre, randomised, double-blind, placebo-controlled phase 3 trial Kadowaki T, Kiyosue A, Shingaki T, et al. · The lancet. Diabetes & endocrinology · 2025 · Randomised controlled trial DOIPubMed 40031941
  10. Tirzepatide and muscle composition changes in people with type 2 diabetes (SURPASS-3 MRI): a post-hoc analysis of a randomised, open-label, parallel-group, phase 3 trial Sattar N, Neeland IJ, Dahlqvist Leinhard O, et al. · The lancet. Diabetes & endocrinology · 2025 · Randomised controlled trial DOIPubMed 40318682
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  13. Body composition changes during weight reduction with tirzepatide in the SURMOUNT-1 study of adults with obesity or overweight Look M, Dunn JP, Kushner RF, et al. · Diabetes, obesity & metabolism · 2025 · Randomised controlled trial DOIPubMed 39996356Full text
  14. Continued Treatment With Tirzepatide for Maintenance of Weight Reduction in Adults With Obesity: The SURMOUNT-4 Randomized Clinical Trial Aronne LJ, Sattar N, Horn DB, et al. · JAMA · 2024 · Randomised controlled trial DOIPubMed 38078870Full text
  15. Tirzepatide for Weight Reduction in Chinese Adults With Obesity: The SURMOUNT-CN Randomized Clinical Trial Zhao L, Cheng Z, Lu Y, et al. · JAMA · 2024 · Randomised controlled trial DOIPubMed 38819983Full text
  16. Tirzepatide for the Treatment of Obstructive Sleep Apnea and Obesity Malhotra A, Grunstein RR, Fietze I, et al. · The New England journal of medicine · 2024 · Randomised controlled trial DOIPubMed 38912654Full text
  17. Tirzepatide vs Insulin Lispro Added to Basal Insulin in Type 2 Diabetes: The SURPASS-6 Randomized Clinical Trial Rosenstock J, Frías JP, Rodbard HW, et al. · JAMA · 2023 · Randomised controlled trial DOIPubMed 37786396Full text
  18. Tirzepatide once weekly for the treatment of obesity in people with type 2 diabetes (SURMOUNT-2): a double-blind, randomised, multicentre, placebo-controlled, phase 3 trial Garvey WT, Frias JP, Jastreboff AM, et al. · Lancet (London, England) · 2023 · Randomised controlled trial DOIPubMed 37385275
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