Boehringer Ingelheim’s survodutide drug has achieved the co-primary endpoints in a phase 3 trial in adults with obesity and Type 2 diabetes. But as the securities fell by 12% in early trading in Denmark, the result fell below the expectations of analysts in the wake of the results from earlier this year.
Weight Loss Results from the Synchronize-2 Study
Results presented at the European Association for the Study of Diabetes’ Annual Meeting in Milan, Italy, are derived from the Synchronize-2 study. Investigators randomized 755 adults to placebo or two different doses of survodutide, a glucagon/GLP-1 receptor dual agonist, given once a week. Boehringer said that at week 76, the mean weight loss was 13.1% with the high dose of survodutide.
The survodutide result met one of the co-primary endpoints of the study, as those taking the placebo lost 3.1% of their body weight. The trial also met its secondary endpoint, with 79.3% of those taking survodutide achieving at least 5% weight loss compared with 32.7% in the placebo group.
Boehringer generated the data in the analyses based on the hypothetical treatment effect that would be seen if all patients followed the trial regimen. A report in the New England Journal of Medicine (NEJM) treated the primary efficacy evaluation differently, though. In those analyses, mean weight loss on placebo and the high dose of survodutide were 3.9% and 9.8%, respectively.
Efficacy Lags Behind Previous Trial Findings
In both types of analysis, there was a lower level of weight loss on survodutide than in Synchronize-1. That was to be expected—Type 2 diabetes patients were excluded from Synchronize-1, which is likely to have led to better weight loss—but leaves Boehringer with the same concerns as were raised at the previous reading.
BMO Capital Markets’ analysts noted in a note to investors from back in June that survodutide had “a less competitive profile vs other agents” in Synchronize-1. Given the data, “it could be more difficult for Zealand/BI to find a competitive foothold in today’s rapidly evolving obesity/metabolic market,” the analysts added.
High Rate of Side Effects and Patient Discontinuations
Those concerns were based on global efficacy and tolerability concerns. In Synchronize-1, 45% of people on the high dose of survodutide had vomiting and 25% discontinued treatment following an adverse event. The Synchronize-2 data is similar, with 26% of people dropping out after an adverse event and 39% vomiting. The NEJM authors postulated that dose escalation was a possible cause of the higher numbers.
Synchronize-2’s secondary endpoint for blood sugar was achieved, while the 1.21% drop in HbA1c is not considered remarkable in this competitive arm. Boehringer also presented data on waist circumference and insulin sensitivity to support the idea that survodutide may have a beneficial effect on metabolic health.
Shares in Zealand, which has licensed the asset to Boehringer, were down 11% to 241 Danish kroner. Development and commercialisation are the responsibility of Boehringer only for the global market. Zealand can earn a maximum of 315 million euros ($355 million) in milestones.
With doubts over survodutide’s competitiveness in weight loss looming over the drug all year, one area where Boehringer has retained hopes is the therapy’s effect on the liver. In the pre-specified analysis of Synchronize-1 back in June, patients on survodutide had liver fat decreased by up to 63.1% versus 25% in the study’s control patients.
Zealand’s Obesity Drug Faces Another Phase 3 Setback
Zealand Pharma’s obesity drug development program highlights the challenges pharmaceutical companies face when advancing new weight-management treatments through late-stage clinical trials. Although obesity medicines have attracted substantial investment and scientific interest, not every promising candidate demonstrates the effectiveness required to meet its primary clinical endpoint.
A Phase 3 trial failure can represent a significant setback for a drug developer, potentially affecting development timelines, investment priorities, and plans for future research. For Zealand Pharma, interpreting the latest results requires examining the specific medicine involved, the trial design, the patient population, and the outcomes measured.
The broader obesity treatment market continues to evolve as companies investigate medicines designed to produce meaningful weight loss while maintaining acceptable safety profiles and improving long-term treatment adherence.
This broader pipeline is important because obesity is a complex, chronic condition, and different patients may respond differently to available therapies. Medicines that offer alternative mechanisms of action or improved tolerability could help expand treatment choices if clinical trials establish their safety and effectiveness.
Conclusion: A Setback in Expectations, Not a Failed Trial
The latest survodutide results have renewed questions about whether the medicine can compete effectively with established weight-loss treatments. However, describing the Phase 3 study as a failure would be inaccurate because the trial met its co-primary endpoints.
The central issue is the balance between weight-loss efficacy, tolerability, and the ability of patients to remain on treatment. Further clinical evidence and comparisons across studies will be important in determining the medicine’s eventual role in obesity care.
For Zealand Pharma, survodutide remains part of a broader development strategy that also includes petrelintide and other metabolic-health programs.
Competition in the Obesity Drug Market
The obesity medicine market has become increasingly competitive, with established treatments from Novo Nordisk and Eli Lilly setting high expectations for weight reduction and patient outcomes.
New drug candidates must demonstrate more than biological activity. They also need to offer a compelling combination of effectiveness, safety, convenience, and treatment persistence.
For Zealand Pharma and its partner, the survodutide results underline the difficulty of competing in a market where clinical performance and tolerability can influence both prescribing decisions and investor confidence.
What Comes Next for Zealand Pharma?
Despite the concerns surrounding survodutide, Zealand Pharma continues to develop other obesity treatments.
Its partnership with Roche includes petrelintide, a long-acting amylin analogue designed as an alternative approach to weight management. The company reported positive Phase 2 results for petrelintide in people with overweight or obesity and type 2 diabetes on October 7, 2026. The program is progressing into Phase 3 development.
