Munawar Nazish, Mahato Aakash, Rawat Anurag, Gill Fahad Shaukat, Kumar Daksh, Katwal Susant, Wei Calvin R, Ali Neelum
Internal Medicine, Alberta Health Services, Edmonton, CAN.
Internal Medicine, Mirbat Hospital, Ministry of Health, Salalah, OMN.
Cureus. 2025 Jun 15;17(6):e86080. doi: 10.7759/cureus.86080. eCollection 2025 Jun.
This systematic review and meta-analysis compared the weight loss efficacy of tirzepatide versus semaglutide in overweight and obese adults through direct comparative studies. We systematically searched PubMed, Excerpta Medica database (EMBASE), Web of Science, and Cochrane Library databases from inception to April 25, 2025, identifying studies that directly compared tirzepatide and semaglutide for weight management. Inclusion criteria encompassed randomized controlled trials and observational studies reporting percentage change in body weight from baseline. Seven studies totaling 28,980 participants were included, comprising five observational studies and two randomized controlled trials with follow-up durations ranging from six to 12 months. Data analysis was performed using Review Manager 5.4.1 (The Cochrane Collaboration, London, UK) with random-effects models. Results demonstrated that tirzepatide was significantly superior to semaglutide in achieving weight reduction. The pooled analysis showed greater weight loss with tirzepatide compared to semaglutide (standardized mean difference: 0.75, 95% CI: 0.52 to 0.92). At six months, tirzepatide achieved significantly greater weight reduction than semaglutide (mean difference: 1.33, 95% CI: 0.58 to 2.08). Additionally, participants receiving tirzepatide had significantly higher odds of achieving at least 10% weight loss compared to those receiving semaglutide (OR: 0.21, 95% CI: 0.06 to 0.78). High heterogeneity was observed across studies (I² > 90%). This meta-analysis provides evidence that tirzepatide, a dual glucose-dependent insulinotropic polypeptide/glucagon-like peptide-1 (GIP/GLP-1) receptor agonist, demonstrates superior weight loss efficacy compared to semaglutide in overweight and obese populations. These findings support tirzepatide as a more effective pharmacological option for weight management, though further long-term head-to-head trials are needed to confirm sustained benefits and safety profiles.
本系统评价和荟萃分析通过直接比较研究，对比了替尔泊肽与司美格鲁肽在超重和肥胖成年人中的减肥效果。我们系统检索了从数据库建立至2025年4月25日的PubMed、医学文摘数据库（EMBASE）、科学网和考克兰图书馆数据库，识别直接比较替尔泊肽和司美格鲁肽用于体重管理的研究。纳入标准包括报告体重相对于基线的百分比变化的随机对照试验和观察性研究。共纳入7项研究，总计28980名参与者，包括5项观察性研究和2项随机对照试验，随访时间为6至12个月。使用Review Manager 5.4.1（英国伦敦考克兰协作组织）进行随机效应模型的数据分析。结果表明，在实现体重减轻方面，替尔泊肽显著优于司美格鲁肽。汇总分析显示，与司美格鲁肽相比，替尔泊肽的体重减轻幅度更大（标准化平均差：0.75，95%置信区间：0.52至0.92）。在6个月时，替尔泊肽实现的体重减轻显著大于司美格鲁肽（平均差：1.33，95%置信区间：0.58至2.08）。此外，与接受司美格鲁肽的参与者相比，接受替尔泊肽的参与者体重减轻至少10%的几率显著更高（比值比：0.21，95%置信区间：0.06至0.78）。各研究间观察到高度异质性（I²>90%）。这项荟萃分析提供了证据，表明双葡萄糖依赖性促胰岛素多肽/胰高血糖素样肽-1（GIP/GLP-1）受体激动剂替尔泊肽在超重和肥胖人群中表现出优于司美格鲁肽的减肥效果。这些发现支持替尔泊肽作为一种更有效的体重管理药物选择，不过需要进一步的长期头对头试验来确认持续的益处和安全性。
