Overview

Boehringer Ingelheim's entry in the glucagon-combination race. Its most interesting phase 2 result was not weight loss but liver histology — a majority of participants with MASH achieved improvement without worsening fibrosis, which is a harder endpoint than weight.

Investigational — not approvedInvestigational. Not approved by any regulator.

At a glance

Regulatory status	Phase 3 (SYNCHRONIZE program) in obesity and in metabolic dysfunction-associated steatohepatitis. Not approved.
Drug class	Dual glucagon / GLP-1 receptor agonist
Route	Subcutaneous, once weekly (investigational)
Half-life	~6 days
Evidence rating	3/5 Moderate Evidence rating 3 out of 5: Moderate Small or early-phase human trials, or good controlled topical human data.
Studied in	Phase 2 obesity and MASH trials; SYNCHRONIZE phase 3 program in obesity, obesity with type 2 diabetes, and MASH.

How it works

Balanced agonism at the glucagon and GLP-1 receptors. GLP-1 suppresses appetite and improves insulin dynamics; glucagon-receptor activity increases hepatic fat oxidation and energy expenditure, which is why the liver signal is stronger than with GLP-1-only agents.

Evidence base

Rated 3 of 5 — Moderate. Small or early-phase human trials, or good controlled topical human data.

Phase 2 with a biopsy-confirmed liver endpoint — unusually rigorous for this stage.
Phase 3 results pending.

Benefits & potential uses

Bars indicate how well each claim is supported: three = strong human evidence, two = moderate, one = preliminary or preclinical.

MASH improvement in phase 2 Moderate evidence

A majority of treated participants achieved histological improvement in steatohepatitis without worsening of fibrosis — a biopsy endpoint, not a surrogate marker.
Substantial weight reduction Moderate evidence

Phase 2 showed roughly 19% mean weight loss at 46 weeks on the highest dose.
Added energy expenditure Preliminary

The glucagon component provides a thermogenic mechanism GLP-1-only drugs lack.

Risks, cons & cautions

Bars indicate seriousness: three = serious or common, two = moderate, one = minor.

Not approved anywhere Serious

Phase 3 is ongoing; efficacy and safety conclusions remain provisional.
High GI adverse event rate Moderate evidence

Nausea and vomiting were common and drove discontinuations in phase 2.
Heart rate increase Moderate evidence

Observed with glucagon-receptor co-agonism across this drug class.
Glycemic uncertainty Moderate evidence

Glucagon agonism raises hepatic glucose output; the net effect depends on incretin balance and needs phase 3 confirmation.
Grey-market sale Serious

Sold illicitly as a research peptide despite having no approved use.

Who should avoid it

Use outside a registered clinical trial

If used under medical supervision, monitor

Not applicable outside trials

Interactions

Not exhaustive. Always have a pharmacist or physician review your full medication list — including supplements.

Insulin and sulfonylureas — hypoglycemia risk if combined
Oral medications with narrow therapeutic windows — delayed gastric emptying alters absorption

Regulatory & legal status

Investigational. Not approved by any regulator.

Infographic

Survodutide — benefits & risks at a glance Download SVG

Where to read further

We link to live literature searches rather than a frozen citation list, so you always see current results — including anything published after our last review.

weight lossMASHliverglucagoninvestigational

Related peptides in Metabolic & Weight

Terms used on this page

Fibrosis: Fibrosis is the accumulation of excess extracellular matrix that replaces functional tissue, representing repair that has failed to resolve rather than a separate disease process.
Phase 2 Trial: A Phase 2 trial is the first test of a compound in the target patient population, sized to find a workable dose and an early efficacy signal rather than to prove clinical benefit.
Metabolic Dysfunction-Associated Steatohepatitis (MASH): MASH is the inflammatory form of metabolic fatty liver disease, defined histologically by steatosis with hepatocyte ballooning and lobular inflammation, with or without fibrosis.
Resting Energy Expenditure (REE): Resting energy expenditure is the energy a body uses at rest in a fasted, thermoneutral state, and it accounts for most of daily total energy expenditure.
Glucagon: Glucagon is a 29-amino-acid pancreatic alpha-cell hormone that raises blood glucose by driving hepatic glycogenolysis and gluconeogenesis, and also increases energy expenditure.
Agonist: An agonist is a ligand that binds a receptor and stabilises its active conformation, producing a biological response rather than merely occupying the binding site.

This page is educational information, not medical advice. It cannot account for your medical history, medications, or risk factors. Do not start, stop or change any treatment based on it. Speak to a qualified healthcare professional who knows your case.