Comparative Study of Tirzepatide Versus Dulaglutide (SURPASS CVOT) or Semaglutide on Major Cardiovascular Events in Participants With Type 2 Diabetes

NCT06779929 — Completed, 70000 participants, Brigham and Women's Hospital

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Comparative Study of Tirzepatide vs Dulaglutide (SURPASS CVOT) or Semaglutide on Major Cardiovascular Events in Participants With Type 2 Diabetes

RegistryNCT06779929
StatusCompleted
Study typeObservational
Enrollment70000 (Actual)
SponsorBrigham and Women's Hospital (Other)
ConditionsType 2 Diabetes
InterventionsTirzepatide, Dulaglutide, Semaglutide (Drug)
Datesstart 2024-11-01, primary completion 2025-12-01, completion 2026-03-01, first posted 2025-01-17, last updated 2026-09-18
Locations1 site in United States

Related Papers Related Patents Related Grants Related Experts
All trials for Type 2 Diabetes All trials of Tirzepatide All trials of Dulaglutide

-Summary

This cohort study was initiated to emulate the design of the SURPASS-CVOT trial using observational analogues of the trial design components in a study based on insurance claims data.

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+Detailed description

Recent evidence suggests that the metabolic effects of glucagon-like peptide-1 receptor agonists (GLP-1RA) can be enhanced by combining them with the actions of other entero-pancreatic hormones, such as glucose-dependent insulinotropic polypeptide (GIP) and/or glucagon. Tirzepatide is a once-weekly GIP/GLP-1RA, approved for the treatment of type 2 diabetes in May 2022.

The Study of Tirzepatide Compared With Dulaglutide on Major Cardiovascular Events in Participants With Type 2 Diabetes (SURPASS-CVOT; NCT04255433) is an event-driven, randomized, double- blind, active comparator, parallel-group study, to evaluate cardiovascular (CV) outcomes with tirzepatide treatment in people with type 2 diabetes (T2D) and established atherosclerotic CV disease (ASCVD) compared with dulaglutide treatment, stratified by baseline sodium-glucose cotransporter-2 (SGLT2) inhibitors use. SURPASS-CVOT was designed to establish CV protection with tirzepatide by demonstrating noninferiority of tirzepatide to dulaglutide, and also to determine whether tirzepatide produces a greater CV benefit than dulaglutide (superiority analysis).

This new user active comparator cohort study aims to emulate the SURPASS-CVOT trial using insurance claims data. Trial design parameters were adapted in claims data using observational analogues for eligibility criteria, treatment strategies, treatment assignment, follow-up start, follow-up end, outcome, and causal contrast. We also conducted HbA1c-adjusted analyses among those with HbA1c values (54% of population).

+Arms and interventions

ArmTypeInterventionsDescription
TirzepatideDrug: TirzepatidePatients who initiated tirzepatide with no use in the prior 180 days
DulaglutideDrug: DulaglutidePatients who initiate dulaglutide with no use in the prior 180 days
SemaglutideDrug: SemaglutidePatients who initiate semaglutide with no use in the prior 180 days
  • Tirzepatide (Drug): Tirzepatide
  • Dulaglutide (Drug): Dulaglutide
  • Semaglutide (Drug): Semaglutide

+Outcome measures

Primary outcomes

  • Composite CV outcome [From treatment initiation to end of follow up, up to 48 months.]: Composite CV outcome includes myocardial infarction, stroke, and all-cause mortality.

+Eligibility

Sex: All, ages: 40 Years to any

Inclusion Criteria:

* Patients with T2D who were new users of tirzepatide or new users of dulaglutide
* AND established ASCVD defined as:

  * History of Myocardial Infarction (MI) or MI sequela
  * Unstable or stable angina
  * Coronary atherosclerosis disease or procedures
  * Ischemic stroke
  * Peripheral arterial disease or procedures
  * Atherosclerotic cerebrovascular disease or cerebrovascular procedures
  * Lower-limb amputation
* Age >= 40 years old
* Patients with at least 180 days of continuous health plan enrollment before and including the treatment initiation date

Exclusion Criteria:

* Patients with Type 1 diabetes mellitus
* Patients with missing age or sex information
* Patients with history of proliferative diabetic retinopathy, panretinal photocoagulation, vitreous hemorrhage, or intravitreal anti-VEGF injection
* Patient within history of left ventricular assisted device (LVAD) or heart transplant
* Patients with any previous organ transplants
* Patients with acute of chronic pancreatitis
* Patients with gastroparesis, bowel obstruction or bariatric surgery
* Patient with CKD Stage 5, end stage kidney disease, kidney transplant, or hemodialysis
* Patients with multiple endocrine neoplasm syndrome type 2 (MEN-2)
* Patient with cancer
* Pregnant women
* Patient with diabetic ketoacidosis or HONK within the last year to treatment initiation
* Patients with acute hepatitis within the last year to treatment initiation
* Patients with elevated serum calcitonin level within the last year to treatment initiation
* Previous exposure to GLP-1RA or pramlintide during the 180-days washout period and including treatment initiation date
* Patients with severe hypoglycemia within the last 6 months to treatment initiation
* Patients with hospitalization for heart failure within the last 60 days to treatment initiation
* Patient with acute coronary syndrome, ischemic stroke, peripheral arterial disease, or coronary or cerebrovascular procedure within the last 60 days to treatment initiation
* Patients with prescription dispensing for both tirzepatide and dulaglutide on treatment initiation date

+Locations (1)

FacilityCityCountryStatus
Brigham and Women's HospitalBoston, MassachusettsUnited States

+Publications

  • Nicholls SJ, Bhatt DL, Buse JB, Prato SD, Kahn SE, Lincoff AM, McGuire DK, Nauck MA, Nissen SE, Sattar N, Zinman B, Zoungas S, Basile J, Bartee A, Miller D, Nishiyama H, Pavo I, Weerakkody G, Wiese RJ, D'Alessio D; SURPASS-CVOT investigators. Comparison of tirzepatide and dulaglutide on major adverse cardiovascular events in participants with type 2 diabetes and atherosclerotic cardiovascular disease: SURPASS-CVOT design and baseline characteristics. Am Heart J. 2024 Jan;267:1-11. doi: 10.1016/j.ahj.2023.09.007. Epub 2023 Sep 25. PMID 37758044
  • Results publication: Ostrominski JW, Ortega-Montiel J, Wexler DJ, Everett BM, Cromer SJ, Byrne CF, Glynn RJ, Paik JM, Patorno E. Comparative Effectiveness of Tirzepatide Versus Dulaglutide or Semaglutide on Major Cardiovascular Events in Type 2 Diabetes and Cardiovascular Disease: Insights From Two Target-Trial Emulations. Diabetes Care. 2026 May 1;49(5):808-817. doi: 10.2337/dc25-3063. PMID 41778928