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  1. Medical Information Right
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  3. Mounjaro (tirzepatide) injection Right
  4. How did Mounjaro® (tirzepatide) compare with placebo as add-on to titrated insulin glargine with or without metformin in SURPASS-5?
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Mounjaro ® (tirzepatide) injection

2.5 mg/5 mg/7.5 mg/10 mg/12.5 mg/15 mg

Full Prescribing Information

This information is provided in response to your request. Resources may contain information about doses, uses, formulations and populations different from product labeling. See Prescribing Information above, if applicable.

How did Mounjaro® (tirzepatide) compare with placebo as add-on to titrated insulin glargine with or without metformin in SURPASS-5?

In patients with T2D with titrated insulin, tirzepatide resulted in superior reduction in HbA1c, FSG, and weight; more participants had a HbA1c <7.0% compared with placebo at week 40. Mounjaro is not a weight loss drug, and individual results may vary.

US_cFAQ_TZP105A_M_USE_WITH_GLARGINE_WITH_OR_WITHOUT_METFORMIN_SURPASS-5_T2D
US_cFAQ_TZP105A_M_USE_WITH_GLARGINE_WITH_OR_WITHOUT_METFORMIN_SURPASS-5_T2Den-US

See important safety information, including boxed warning, in the attached prescribing information.

Content Overview 

SURPASS-5 Overview

  • Study Design in SURPASS-5
  • Efficacy Results From SURPASS-5
  • Safety Results From SURPASS-5

SURPASS-5 Overview

Mounjaro (tirzepatide) is a glucose-dependent insulinotropic polypeptide (GIP) and glucagon-like peptide-1 (GLP-1) receptor agonist indicated as an adjunct to diet and exercise to improve glycemic control in adults with type 2 diabetes (T2D) for once-weekly, subcutaneous administration.1

SURPASS-5 was a 40-week, phase 3, double-blind, randomized study of tirzepatide 5, 10, and 15 mg once weekly compared with placebo in 475 adults with T2D, as add-on to titrated insulin glargine with or without metformin.2

Key Inclusion and Exclusion Criteria in SURPASS-5

Key inclusion and exclusion criteria for the SURPASS-5 study are presented in Key Inclusion and Exclusion Criteria in SURPASS-5.

Key Inclusion and Exclusion Criteria in SURPASS-52

Key Inclusion Criteria

Key Exclusion Criteria

  • T2D
  • HbA1c ≥7.0% to ≤10.5% at screening
  • BMI ≥23 kg/m2 with stable weighta
  • Stable dose of once-daily insulin glargine (>0.25 IU/kg/day or >20 IU/day) with or without metformin in the 3 months prior to screening
  • Requirement for increased insulin glargine dose at randomization
  • T1D
  • History of pancreatitis
  • eGFR <30 mL/min/1.73m2 (<45 mL/min/1.73m2 if on metformin)
  • History of proliferative diabetic retinopathy or maculopathy (or nonproliferative diabetic retinopathy requiring acute treatment).

Abbreviations: BMI = body mass index; eGFR = estimated glomerular filtration rate; HbA1c = glycated hemoglobin; IU = international unit; T1D = type 1 diabetes; T2D = type 2 diabetes.

aNo change in weight outside of ±5% during the previous 3 months and agree to not initiate a diet and/or exercise program during the study with the intent of reducing body weight.

Study Design in SURPASS-5

SURPASS-5 randomized 475 study participants across the Czech Republic, Germany, Japan, Poland, Puerto Rico, Slovakia, Spain, and the United States in 1:1:1:1 ratio to receive either tirzepatide 5, 10, or 15 mg, or placebo as add-on to insulin glargine with or without metformin.2

The primary objective of this study was to demonstrate that tirzepatide 10 and/or 15 mg when added to titrated insulin glargine are superior when compared with placebo for mean change from baseline in glycated hemoglobin (HbA1c) at 40 weeks.2

SURPASS-5 Study Design presents an overview of the SURPASS-5 study design.

SURPASS-5 Study Design2

Figure description: SURPASS-5 was a phase 3, 40-week, double-blind, placebo-controlled study in adults with type 2 diabetes where participants were randomized in a 1:1:1:1 ratio to receive tirzepatide (5 mg, 10 mg, or 15 mg) or placebo once weekly subcutaneously as add-on to insulin glargine with or without metformin. Tirzepatide-treated participants started at a 2.5 mg dose and followed a dose escalation regimen (escalated in 2.5 mg increments every 4 weeks) until the assigned dose was reached, which took up to 20 weeks. Insulin glargine was titrated in all arms during the insulin titration period from weeks 5 to 40 following a treat-to-target algorithm with the goal of fasting serum glucose (FSG) <5.6 mmol/L. Tirzepatide and placebo were given with once-daily insulin glargine ± metformin.

Abbreviation: QW = once weekly.

a Stabilization period = first 4 weeks after randomization, with restricted insulin dose adjustments. Insulin glargine titration period weeks 4 to 40 (end of treatment/end of study), with unrestricted insulin dose adjustments. Maintenance period = weeks 24 to 40 (end of treatment/end of study), the period when insulin glargine dose is expected to be stable.

Baseline Characteristics of Participants in SURPASS-5 

In SURPASS-5, baseline demographics and clinical characteristics were similar across all treatment groups. At baseline, participants had a mean 

  • age of 61 years 
  • body mass index (BMI) of 33.4 kg/m2
  • duration of diabetes of 13.3 years, and
  • HbA1c of 8.31%.2

In the overall study population, the median insulin glargine dose was 30.0 IU/d and 82.9% of participants were using metformin.2

Baseline demographics and clinical characteristics of randomized patients are presented in SURPASS-5: Baseline Demographics and Clinical Characteristics.2

Discontinuations During the SURPASS-5 Study

Treatment discontinuation in SURPASS-5 is summarized in Summary of Treatment Discontinuation in SURPASS-5 . In all treatment groups, the most common reasons for study drug discontinuation were adverse events (AEs).2

Summary of Treatment Discontinuation in SURPASS-52 

Parameter​a

Tirzepatide 5 mg
N=116​

Tirzepatide 10 mg​
N=119​

Tirzepatide 15 mg​
N=120​

Placebo​
N=120​

Overall treatment discontinuation

11 (9.5)

14 (11.8)

22 (18.3)

4 (3.3)

aData are n (%); all randomized patients.

Efficacy Results From SURPASS-5

Two statistical estimands, efficacy or treatment-regimen, were used to evaluate efficacy data from the phase 3 clinical trials of tirzepatide. In the SURPASS studies, the 

  • efficacy estimand evaluates the treatment effect prior to discontinuation of the study drug without confounding effects of antihyperglycemic rescue therapy, and 
  • treatment-regimen estimand evaluates the treatment effect irrespective of adherence to the study drug or initiation of rescue antidiabetic drugs.2

Differences in reported data may reflect the application of these estimands. This response presents data reflecting the efficacy estimand. For treatment-regimen estimand results, please refer to the manuscript cited and/or the US prescribing information, where applicable.2

In the SURPASS-5 study at week 40, tirzepatide 5, 10, and 15 mg were superior compared with placebo in

  • mean change in HbA1c
  • mean change in FSG
  • mean change in weight, and
  • proportion of participants at HbA1c threshold <7.0% (Key Efficacy Endpoints at Baseline and Week 40 in SURPASS-5).2

Additional secondary endpoints are presented in Key Efficacy Endpoints at Baseline and Week 40 in SURPASS-5.

Key Efficacy Endpoints at Baseline and Week 40 in SURPASS-52,3

Parametera

Tirzepatide 5 mg
N=116

Tirzepatide 10 mg
N=119

Tirzepatide 15 mg
N=120

Placebo
N=120

HbA1c, %

Baseline

8.29±0.08

8.34±0.08

8.22±0.08

8.39±0.08

Change from baseline 

-2.23±0.08

-2.59±0.08

-2.59±0.08

-0.93±0.08

Difference vs placebob

-1.30 (-1.52, -1.07)**

-1.66 (-1.88, -1.43)**

-1.65 (-1.88, -1.43)**

--

Proportion of participants at HbA1c thresholds, n (%)

<7.0%b

107 (93.04)**

110 (97.35)**

110 (94.02)**

40 (33.90)

≤6.5%c

92 (80.00)**

107 (94.69)**

108 (92.31)**

20 (16.95)

<5.7%d

30 (26.09)**

54 (47.79)**

73 (62.39)**

3 (2.54)

FSG, mg/dL

Baseline

162.2±4.81

162.9±4.79

160.4±4.75

164.4±4.75

Change from baseline

-61.4±2.55

-67.9±2.55

-67.7±2.64

-38.9±2.49

Difference vs placebob

-22.5 (-29.5, -15.4)**

-29.0 (-36.0, -22.0)**

-28.8 (-35.9, -21.6)**

--

Body weight, kg

Baseline

95.5±2.02

95.4±2.03

96.2±2.00

94.1±1.99

Change from baseline

-6.2±0.58

-8.2±0.58

-10.9±0.59

1.7±0.57

Difference vs placebob

-7.8 (-9.4, -6.3)**

-9.9 (-11.5, -8.3)**

-12.6 (-14.2, -11.0)**

--

Proportion of participants at body weight reduction thresholds, n (%)

≥5%c

62 (53.91)**

73 (64.60)**

99 (84.62)**

7 (5.93)

≥10%c

26 (22.61)**

53 (46.90)**

60 (51.28)**

1 (0.85)

≥15%c

8 (6.96)*

30 (26.55)*

37 (31.62)**

0 (0.00)

Insulin glargineedose (IU/day)

Baseline

34.3±1.45

32.0±1.34

35.0±1.46

32.9±1.36

Percent change from baseline

13.0±7.34

8.1±7.03

-11.4±5.85

75.0±11.1

Difference vs placeboc

-35.4 (-46.0, -22.8)**

-38.2 (-48.3, -26.1)**

-49.3 (-57.7, -39.4)**

--

Abbreviations: FSG = fasting serum glucose; HbA1c = glycated hemoglobin; LSM = least squares mean; mITT = modified intention-to-treat; MMRM = mixed-effects model for repeated measures; TTT = treat-to-target.

Note: Efficacy estimand is efficacy prior to discontinuation of study drug without confounding effects of antihyperglycemic rescue therapy. Missing values were implicitly handled by MMRM using the mITT population, efficacy analysis set.

*p<0.05 and **p<0.001 vs placebo.

aData are LSM±SE, n (%), or LSM (95% CI) treatment difference vs placebo at 40 weeks.

bTested for superiority, controlled for type 1 error. 

cTested for superiority, not controlled for type 1 error.

dTested for superiority; tirzepatide 10 mg and 15 mg versus placebo was controlled for type 1 error, while tirzepatide 5 mg was not controlled for type 1 error.

eInsulin glargine was titrated from week 5 through 40 using a TTT algorithm to reach target FSG <100 mg/dL.

Safety Results From SURPASS-5

The most frequently reported AEs for tirzepatide were gastrointestinal in nature. Most gastrointestinal events 

  • were mild to moderate in severity, and
  • usually occurred during the dose escalation period, and decreased overtime.2 

Overview of AEs and treatment-emergent adverse events (TEAEs) with ≥5% frequency are provided in Overview of Adverse Events Through 40 Weeks in SURPASS-5  and Treatment-Emergent Adverse Events With ≥5% Frequency Through 40 Weeks in SURPASS-5.2

Overview of Adverse Events Through 40 Weeks in SURPASS-52 

Parameter​a

Tirzepatide 5 mg​
N=116​

Tirzepatide 10 mg​
N=119​

Tirzepatide 15 mg​
N=120​

Placebo​
N=120​

Patients with ≥1 TEAE​

85 (73.3)​

81 (68.1)​

94 (78.3)​

81 (67.5)​

SAEb

9 (7.8)​

13 (10.9)​

9 (7.5)​

10 (8.3)​

Death​

0​

0​

0​

0​

AEs leading to study drug discontinuation

7 (6.0)

10 (8.4)

13 (10.8)

3 (2.5)

Abbreviations: AE = adverse event; SAE = serious adverse event; TEAE = treatment-emergent adverse event.  

aData are n (%); all randomly assigned patients exposed to at least 1 dose of the study drug with all data from the start of study treatment to the end of safety follow-up (safety analysis set). Patients may be counted in more than 1 category.

bSerious adverse event was defined as any adverse event that resulted in death, initial or prolonged inpatient hospitalization, a life-threatening experience, persistent or significant disability or incapacity, congenital anomaly or birth defect, or medical events that may not be immediately life-threatening or result in death or hospitalization but jeopardized the patient’s health or required intervention to prevent the previously listed events

Treatment-Emergent Adverse Events With ≥5% Frequency Through 40 Weeks in SURPASS-52

Parametera​

Tirzepatide 5 mg​
N=116​

Tirzepatide 10 mg​
N=119​

Tirzepatide 15 mg​
N=120​

Placebo​
N=120​

Diarrhea​

14 (12.1)​

15 (12.6)​

25 (20.8)​

12 (10.0)​

Nasopharyngitis​

18 (15.5)​

8 (6.7)​

15 (12.5)​

23 (19.2)​

Nausea​

15 (12.9)​

21 (17.6)​

22 (18.3)​

3 (2.5)​

Decreased appetite​

8 (6.9)​

15 (12.6)​

17 (14.2)​

2 (1.7)​

Vomiting​

8 (6.9)​

9 (7.6)​

15 (12.5)​

3 (2.5)​

Dyspepsia​

8 (6.9)​

10 (8.4)​

6 (5.0)​

2 (1.7)​

Constipation​

7 (6.0)​

8 (6.7)​

8 (6.7)​

2 (1.7)​

Back pain​

6 (5.2)​

6 (5.0)​

4 (3.3)​

7 (5.8)​

Hyperglycemia​

2 (1.7)​

0 (0.0)​

1 (0.8)​

16 (13.3)​

Eructation​

6 (5.2)​

4 (3.4)​

7 (5.8)​

1 (0.8)​

Lipase increased​

4 (3.4)​

2 (1.7)​

10 (8.3)​

2 (1.7)​

Flatulence​

3 (2.6)​

6 (5.0)​

7 (5.8)​

0 (0.0)​

Arthralgia​

6 (5.2)​

4 (3.4)​

3 (2.5)​

2 (1.7)​

Hypertension​

3 (2.6)​

3 (2.5)​

1 (0.8)​

7 (5.8)​

Abbreviation: TEAE = treatment-emergent adverse event. 

aData are n (%) of TEAE with ≥5% frequency in any arm; safety analysis set. Patients may be counted in more than 1 category.​

Hypoglycemia frequency is provided in Hypoglycemia Frequency Through 40 Weeks in SURPASS-5.

Hypoglycemia Frequency Through 40 Weeks in SURPASS-52

Parametera​

Tirzepatide 5 mg
N=116​

Tirzepatide 10 mg​
N=119​

Tirzepatide 15 mg​
N=120​

Placebo​
N=120​

Hypoglycemia (BG ≤70 mg/dL)

70 (60.3)​

75 (63.0)​

72 (60.0)​

73 (60.8)​

Hypoglycemia (BG <54 mg/dL)

18 (15.5)​

23 (19.3)​

17 (14.2)​

15 (12.5)​

Severe hypoglycemiab

0​

2 (1.6)​

1 (0.8)​

0​

Abbreviation: BG = blood glucose.

aData are n (%); safety analysis set. Patients may be counted in more than 1 category. Data after initiation of new glucose-lowering therapy not included.

bEpisodes requiring the assistance of another person to actively administer carbohydrate, glucagon, or other resuscitative actions.

Enclosed Prescribing Information

MOUNJARO® (tirzepatide) injection, for subcutaneous use, Lilly

References

The published reference below is available by contacting 1-800-LillyRx (1-800-545-5979).

1Mounjaro [package insert]. Indianapolis, IN: Eli Lilly and Company; 2025.

2Dahl D, Onishi Y, Norwood P, et al. Effect of subcutaneous tirzepatide vs placebo added to titrated insulin glargine on glycemic control in patients with type 2 diabetes: the SURPASS-5 randomized clinical trial. JAMA. 2022;327(6):534-545. https://doi.org/10.1001/jama.2022.0078

3Data on file, Eli Lilly and Company and/or one of its subsidiaries.

Appendix

Baseline Demographics and Clinical Characteristics in SURPASS-5 

SURPASS-5: Baseline Demographics and Clinical Characteristics2

Parameter​a

Tirzepatide 5 mg​
(N=116)​

Tirzepatide 10 mg
(N=119)​

Tirzepatide 15 mg​
(N=120)​

Placebo
(N=120)​

Age (y)​

62±10

60±10

61±10

61±10

Women, n (%)​

55 (47)​

47 (39)​

55 (46)​

54 (45)​

Men, n (%)

61 (53)

72 (61)

65 (54)

66 (55)

Race, n (%)​

American Indian or Alaska Native

0 (0.0)

1 (0.8)

1 (0.8)

0 (0.0)

White​

95 (81.9)​

94 (79.7)​

94 (78.3)​

97 (81.5)​

Asian​

20 (17.2)​

21 (17.8)​

22 (18.3)​

22 (18.5)​

Black or African American​

1 (0.9)​

2 (1.7)​

3 (2.5)​

0 (0.0)​

Duration of diabetes (y)​

14.1±8.1​

12.6±6.2​

13.7±7.5​

12.9±7.4​

HbA1c, mmol/mol

67.1±9.58

67.7±9.01

66.4±9.24

68.2±9.09

≤8.0%, n (%)​

52 (44.8)​

49 (41.5)​

52 (43.3)​

48 (40.0)​

>8.0%, n (%)​

64 (55.2)​

69 (58.5)​

68 (56.7)​

72 (60.0)​

FSG, mmol/L (mg/dL)

9.00±2.97 (162.9±53.9​) 

9.04±2.92 (162.3±52.0​) 

8.91±3.04 (160.3±54.2)​ 

9.13±2.50 (164.1±45.0​) 

Using metformin, n (%)​

99 (85.3)​

99 (83.2)​

97 (80.8)​

99 (82.5)​

Insulin glargine dose​, median (IQR)

IU​

30.0 (24.0-45.0)

29.0 (22.0-43.0)

32.0 (22.0-47.0)

30.0 (23.0-44.5)

IU/kg/day​

0.34 (0.28-0.46)

0.32 (0.25-0.51)

0.34 (0.26-0.49)

0.36 (0.26-0.46)​

Weight (kg)​

95.8±19.8​

94.5±22.2​

96.3±22.8​

94.1±21.8​

BMI (kg/m2)​

33.6±5.9​

33.4±6.2​

33.4±5.9​

33.2±6.3​

Abbreviations: BMI = body mass index; FSG = fasting serum glucose; HbA1c = glycated hemoglobin; IQR = interquartile range; mITT = modified intention-to-treat.

aData are mean±SD, unless otherwise specified; mITT population (all randomly assigned participants who took at least 1 dose of the study drug).

Date of Last Review: June 09, 2025

Additional related information:

  • Tirzepatide as an Add-On for Participants with Inadequate Glycemic Control Using Basal Insulin - Pooled Subgroup Analysis of SURPASS-5 and -6
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