What this page establishes
- SURPASS-2 randomised 1,879 adults with type 2 diabetes to tirzepatide 5, 10 or 15 mg or semaglutide 1 mg weekly for 40 weeks. HbA1c fell 2.01, 2.24 and 2.30 percentage points versus 1.86 for semaglutide.
- Ozempic is licensed for glycaemic control, cardiovascular risk reduction in type 2 diabetes with established cardiovascular disease, and kidney outcomes in type 2 diabetes with chronic kidney disease.
- Mounjaro is licensed for glycaemic control in adults and paediatric patients aged 10 and over with type 2 diabetes, with no cardiovascular or renal outcome indication on its label.
Quick answers
Which lowers blood sugar more?
In SURPASS-2, tirzepatide at all three doses lowered HbA1c more than semaglutide 1 mg over 40 weeks.
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The comparison was against 1 mg, and Ozempic is now licensed up to 2 mg, so the trial does not settle the question at current maximum doses.Which is better for the heart?
Ozempic carries a licensed cardiovascular risk reduction indication for type 2 diabetes with established cardiovascular disease.
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Mounjaro does not carry one. That is a statement about what has been demonstrated to regulators, not a claim that tirzepatide is bad for the heart.Can either be prescribed for weight loss?
Not on these labels. The weight-licensed versions of the same two molecules are Wegovy and Zepbound.
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Ozempic and Mounjaro are the two diabetes brands people most often weigh against each other, and SURPASS-2 compared them directly. Over 40 weeks, tirzepatide lowered HbA1c more than semaglutide 1 mg at every dose tested.
The trial
SURPASS-2 randomised 1,879 adults with type 2 diabetes on metformin to tirzepatide 5, 10 or 15 mg or semaglutide 1 mg, all once weekly, for 40 weeks. Mean baseline HbA1c was 8.28% and mean baseline weight 93.7 kg.
HbA1c fell 2.01, 2.24 and 2.30 percentage points on tirzepatide 5, 10 and 15 mg against 1.86 points on semaglutide. Tirzepatide was non-inferior and then superior on the primary endpoint, and produced greater weight reduction as well.
One design detail matters when reading this: the comparator was semaglutide 1 mg, which was the maximum Ozempic dose at the time. Ozempic now goes to 2 mg. The trial did not test that.
What the labels say, which is not the same question
Ozempic is licensed for glycaemic control in type 2 diabetes, for cardiovascular risk reduction in type 2 diabetes with established cardiovascular disease, and for kidney outcomes in type 2 diabetes with chronic kidney disease.
Mounjaro is licensed for glycaemic control in adults and children aged 10 and over with type 2 diabetes. It carries no cardiovascular or renal outcome indication.
So on HbA1c the trial favours tirzepatide, and on licensed outcome claims Ozempic has two that Mounjaro does not. Those are different things and a comparison that reports only the first is incomplete.
The evidence, one row per claim
| Claim | Tier | Source |
|---|---|---|
| SURPASS-2 randomised 1,879 adults with type 2 diabetes to tirzepatide 5, 10 or 15 mg or semaglutide 1 mg weekly for 40 weeks. HbA1c fell 2.01, 2.24 and 2.30 percentage points versus 1.86 for semaglutide. | established | SURPASS-2, New England Journal of Medicine |
| Ozempic is licensed for glycaemic control, cardiovascular risk reduction in type 2 diabetes with established cardiovascular disease, and kidney outcomes in type 2 diabetes with chronic kidney disease. | established | FDA Structured Product Label, NDA209637 (via openFDA) |
| Mounjaro is licensed for glycaemic control in adults and paediatric patients aged 10 and over with type 2 diabetes, with no cardiovascular or renal outcome indication on its label. | established | FDA Structured Product Label, NDA215866 (via openFDA) |
Sources
- SURPASS-2, New England Journal of Medicine
- FDA Structured Product Label, NDA209637 (via openFDA)
- FDA Structured Product Label, NDA215866 (via openFDA)
Keep reading
- Wegovy vs Zepbound: The Head-to-Head Trial, and What It MeasuredMost brand comparisons infer from separate trials. This one has a randomised head-to-head, which makes it the
- Ozempic vs Wegovy: Same Drug, Different Licence and Maximum DoseTwo brands, one molecule. The difference is regulatory and it is only 0.4 mg wide.
- Trulicity vs Ozempic: Two Weekly Injections, One Real Licence DifferenceThe head-to-head favours semaglutide. The label favours dulaglutide on one specific population, and that is us