Semaglutide vs Tirzepatide Dosages for Weight Loss

Abstract

To the Editor The Original Investigation by Rodriguez et al 1 compared the effectiveness of semaglutide and tirzepatide, each labeled for type 2 diabetes (T2D), in promoting weight loss among adults with overweight or obesity. Tirzepatide was associated with greater weight loss than semaglutide. However, the study did not account for differences in dosages, despite the known dose-response relationship with weight loss for both medications. Accounting for dosage is especially important given that only formulations labeled for T2D were assessed. Consequently, it is likely that semaglutide users receiving the 2.4-mg dosage regimen-the higher dosing recommended only for weight loss-were excluded. 2 Semaglutide and tirzepatide have different approved regimens for T2D management and weight management. Semaglutide has a higher approved dosage for weight management than for T2D, whereas the approved dosage ranges for tirzepatide are the same for both indications. Specifically, semaglutide is approved for T2D under the label for Ozempic (Novo Nordisk), with an initial once-weekly maintenance dose of 0.5 mg, and possible escalation to 1 or 2 mg. For weight management, it is approved under the label for Wegovy (Novo Nordisk), with a recommended maintenance dose of 2.4 mg, or 1.7 mg if not tolerated. 2 Tirzepatide is approved for T2D under the label for Mounjaro (Eli Lilly) and for weight management under the label for Zepbound (Eli Lilly). 3 Both have recommended weekly maintenance doses ranging from 5 to 15 mg, dependent on treatment response and tolerance.