Survodutide

GLP-1/glucagon receptor dual agonist · Also known as BI 456906

What is survodutide?

A dual-acting peptide that activates both GLP-1 and glucagon receptors, producing significant weight loss while also improving liver fat and metabolic markers. Developed by Boehringer Ingelheim and Zealand Pharma.

Survodutide represents a newer approach to obesity treatment by targeting two receptors instead of one. Unlike pure GLP-1 agonists, adding glucagon receptor activity increases energy expenditure and promotes liver fat reduction, making it especially promising for people with metabolic dysfunction-associated steatohepatitis (MASH). It has received FDA Breakthrough Therapy designation for MASH.

Key takeaway: Survodutide achieved up to 18.7% weight loss in phase 2 trials and showed groundbreaking results in reducing liver fat and fibrosis in MASH, with phase 3 trials now fully enrolled.

Benefits & evidence

Weight loss High confidence
Liver fat reduction High confidence
MASH improvement High confidence
Blood sugar control Moderate confidence
Fibrosis improvement Moderate confidence

How it works

Survodutide binds to both GLP-1 and glucagon receptors, activating two complementary metabolic pathways. The GLP-1 component suppresses appetite, slows gastric emptying, and improves insulin sensitivity, similar to semaglutide. The glucagon component adds something unique: it increases hepatic fat oxidation and energy expenditure, helping the body burn more calories and clear fat from the liver.

This dual mechanism is why survodutide shows particular promise for MASH, where excess liver fat drives disease progression. By simultaneously reducing caloric intake through appetite suppression and increasing fat metabolism through glucagon signaling, survodutide addresses obesity from both sides of the energy balance equation.

Dosing information

Typical dosing protocol
Starting dose

0.6 mg/week

Weeks 1-2 (then titrate biweekly)
Maintenance dose

2.4-4.8 mg/week

After 20-week titration

Phase 2 trials used biweekly dose escalation over 20 weeks, increasing from 0.6 mg to target dose. Phase 3 trials are testing doses up to 6.0 mg/week. Not yet approved for clinical use.

Side effects

Most side effects tend to improve as your body adjusts.

Nausea Common
Diarrhea Common
Vomiting Common
Constipation Common
Decreased appetite Moderate
Pancreatitis Rare

Research (10 studies)