Design: Phase 3, multinational, double-blind, randomised, placebo-controlled (SYNCHRONIZE-2)
Population: 752 adults with type 2 diabetes and BMI ≥27; mean age 55.7, mean BMI 36.5
Primary outcome: Percent weight change and ≥5% weight loss at 76 weeks
Effect: −9.8% (6.0 mg) and −8.2% (3.6 mg) vs −3.9% placebo; ≥5% loss 64.5%/57.6% vs 35.1%

SYNCHRONIZE-2 randomised 752 adults with type 2 diabetes and a BMI of 27 or more to once-weekly subcutaneous survodutide (3.6 mg or 6.0 mg) or placebo for 76 weeks. Survodutide activates both the glucagon and the GLP-1 receptor.

Mean weight fell 8.2% on 3.6 mg and 9.8% on 6.0 mg, against 3.9% on placebo; loss of at least 5% reached 57.6%, 64.5% and 35.1% of participants. HbA1c, from a baseline of 7.4%, fell by about 0.9 and 0.8 percentage points versus 0.2 on placebo. Gastrointestinal effects were common — around three-quarters on active drug against 39% on placebo — but usually mild to moderate and transient.

This is phase 3 efficacy against placebo, not a head-to-head with semaglutide or tirzepatide. The drug is investigational: not approved by the FDA, EMA or CDSCO, and not available to prescribe in India. It widens the incretin field rather than settling a choice.

Weight fell about 8–10% over 76 weeks on survodutide versus about 4% on placebo.
HbA1c dropped by roughly 0.8–0.9 points from a baseline of 7.4% on active treatment.
Expect gastrointestinal effects in most patients early; they were generally mild and settled.
The comparator was placebo, so this does not rank survodutide against existing incretin drugs.
Survodutide is investigational and not yet available to prescribe in India.

Why it matters

It signals dual agonists are advancing in diabetes-with-obesity, though it does not yet change what you can prescribe.

The statistics, in plain English

The weight difference from placebo is large and consistent across both doses; the trial was not built to separate the two active doses or to compare survodutide with other incretins, so the ranking question stays open.