Survodutide

In simple words

Survodutide acts like two hormones — a satiety hormone and glucagon, which makes the liver burn fat. It is studied mainly in fatty liver disease; in a study, liver inflammation resolved in most participants.

What this molecule is

29 amino acids, based on oxyntomodulin. A dual GLP-1/glucagon agonist. GLP-1/glucagon ratio ~5:1. A fatty acid allows once-weekly administration.

Why it is studied

A breakthrough in MASH: Phase II NEJM (n=293) — resolution of steatohepatitis without worsening of fibrosis in 83%. This is the best result among all drugs for MASH as of 2025. Weight loss −18.7%.

How it works

GLP-1 component: ↓appetite, ↑insulin. Glucagon component: ↑fatty acid β-oxidation in hepatocytes (the main mechanism in MASH), ↑thermogenesis, ↓hepatic de novo lipogenesis. The 5:1 ratio provides a metabolic effect without hyperglycemia.

Doses used in studies

Studies used titration 0.3 → 1.2 → 2.4 → 4.8 → 6.0 mg/week SC. Course in the studies: 46–48 weeks.

Combined with in studies

• Metformin
• Pioglitazone — in studies in MASH

Level of evidence

Level A Human clinical trials. There are randomized controlled trials (RCTs), or the compound has been approved by a regulatory agency. The most reliable level. Phase II in NEJM in MASH. Phase III (SYNCHRONIZE) ongoing.

Important to know

Honest caveat: Not approved. Nausea 41%, diarrhea 21%. MASH data — Phase II biopsy, n=293. In studies it was not combined with other GLP-1 agonists.

Studies in PubMed

1. A Phase 2 Randomized Trial of Survodutide in MASH and Fibrosis. (N Engl J Med, 2024)
2. 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)
3. Survodutide, a glucagon receptor/glucagon-like peptide-1 receptor dual agonist, improves blood pressure in adults with obesity: A post hoc analysis from a randomized, placebo-controlled, dose-finding, phase 2 trial. (Diabetes Obes Metab, 2025)
4. Subgroup analysis by sex and baseline BMI in people with a BMI ≥27 kg/m2 in the phase 2 trial of survodutide, a glucagon/GLP-1 receptor dual agonist. (Diabetes Obes Metab, 2025)
5. Survodutide for treatment of obesity: rationale and design of two randomized phase 3 clinical trials (SYNCHRONIZE™-1 and -2). (Obesity (Silver Spring), 2025)