Does mounjaro give the same, or better cardiovascular protection, than trulicity? New analysis sheds light

As blogged previously , the SURPASS-CVOT cardiovascular outcome trial comparing tirzepatide (mounjaro) vs dulaglutide (Trulicity) in people with type 2 diabetes found that tirzepatide provided similar protection from CV events as dulaglutide. Given that tirzepatide is much more effective for blood sugar lowering and weight loss, it was perhaps a bit surprising that tirzepatide didn’t perform better than dulaglutide.

A new post hoc analysis of the SURPASS-CVOT data, published in JAMA Cardiology, suggests that with more broadly inclusive CV events, tirzepatide may indeed have performed better than dulaglutide.

Let’s go through some jargon of what a CV event is exactly, as analyzed in this study.

In the SURPASS-CVOT trial, the primary endpoint was a composite of three CV endpoints: cardiovascular death, nonfatal heart attack, and nonfatal stroke. The trial found no significant difference between tirzepatide and dulaglutide for this primary endpoint.

In the current analysis, authors expanded the CV endpoint criteria, and found:

a 4 component CV endpoint (add on coronary revascularization): 14% greater reduction in risk with tirzepatide
a 5 component CV endpoint (add on hospitalization for heart failure): 14% greater reduction in risk with tirzepatide
a 6 component CV endpoint (add on composite of adverse kidney outcomes): 16% greater reduction in risk with tirzepatide (said another way: if you treat 27 people with tirzepatide for about 4 years, one event will be prevented)

While this study was a post hoc secondary analysis and thus should be taken with a grain of salt, this broader analysis appreciates that people with diabetes and obesity can experience a broad range of heart and kidney issues, and does a better job of taking these broader issues into account than the more narrow primary endpoint of the SURPASS-CVOT study. It also does a better job of reflecting the broad benefits that tirzepatide can provide to cardiometabolic health.

BOTTOM LINE: This analysis of the SURPASS-CVOT trial suggests that when viewed more broadly, tirzepatide performs better than dulaglutide (Trulicity) to provide heart/kidney protection in people with type 2 diabetes and cardiovascular disease.

Disclaimer: I am/have been an investigator in clinical trials of tirzepatide and dulaglutide. I receive honoraria as a continuing medical education speaker and consultant from the makers of tirzepatide and dulaglutide (Eli Lilly).

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