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Switching to Tirzepatide Outweighs Escalating Dulaglutide Dose in T2D: SURPASS-SWITCH Trial
Breaking research presented at ACP Internal Medicine 2025 showed that switching GLP1-RAs resulted in better glucose and weight control among adults with inadequately controlled T2D.
Among adults with type 2 diabetes (T2D) inadequately controlled on lower doses of dulaglutide, switching to tirzepatide resulted in greater reductions in hemoglobin A1c (HbA1c) and body weight at 40 weeks compared with escalating the dose of dulaglutide, according to results from a phase 4 randomized trial presented at the 2025 American College of Physicians Internal Medicine Meeting.
The open-label, multicenter SURPASS-SWITCH trial (NCT05564039) enrolled 282 adults with T2D who had HbA1c levels ranging from 7.0% to 9.5%, stable body weight, and a body mass index (BMI) of 25 kg/m² or greater. All participants had been receiving a stable dose of dulaglutide 0.75 or 1.5 mg weekly for at least 6 months, with or without up to 3 oral antihyperglycemic agents.
Participants were randomized to either escalation of dulaglutide to 4.5 mg or the maximum tolerated dose (MTD) (n = 143) or to switch to tirzepatide, 15 mg or MTD (n = 139), administered once weekly.
At 40 weeks, the adjusted mean change from baseline in HbA1c was −1.44% (SE, 0.07) in the tirzepatide group compared with −0.67% (SE, 0.08) in the dulaglutide group. The estimated treatment difference was −0.77% (95% CI, −0.98% to −0.56%; P < .001).
Participants in the tirzepatide group also experienced greater weight loss compared with those continuing dulaglutide. Mean weight change was −10.5 kg (SE, 0.5) compared to −3.6 kg (SE, 0.5), respectively, with an estimated treatment difference of −6.9 kg (95% CI, −8.3 to −5.5 kg; P < .001).
Serious adverse events occurred in 10 participants in each group (7.2% in the tirzepatide group and 7.0% in the dulaglutide group). The most commonly reported treatment-emergent adverse events were nausea and diarrhea.
The authors noted the open-label study design as a limitation. However, they concluded that in patients whose T2D is not adequately controlled on lower doses of dulaglutide, switching to tirzepatide may offer additional clinical benefit in terms of glycemic control and weight reduction.
The study was presented by Liana K. Billings, MD, and the findings were simultaneously published in the Annals of Internal Medicine.
Reference: Billings LK, Winne L, Sharma P, et al. Comparison of dose escalation versus switching to tirzepatide among people with type 2 diabetes inadequately controlled on lower doses of dulaglutide: A randomized clinical trial. Ann Intern Med. Published online April 4, 2025. doi:10.7326/ANNALS-24-03849
