All research presented at ACG 2025 is strictly embargoed until 12:00 pm local Arizona Time, which aligns with Pacific Daylight Time (PDT)/3:00 pm ET on Sunday, October 26, 2025.
Oral 31 – Comparative Efficacy of Tirzepatide vs. Semaglutide on Liver and Cardiovascular Related Outcomes in Patients with MASLD/MASH, Obesity, and Type 2 Diabetes Mellitus: A Real-World Cohort Study
Tuesday, October 28, 2025 | 9:00 AM – 9:10 AM PDT | North Ballroom 120BC
Author Insight from Basil Jalamneh, MD
What’s new here and important for clinicians?
First large, head-to-head real-world comparison of tirzepatide vs semaglutide in MASLD + T2DM + obesity, ~14k per cohort, followed up to 2 years, using a new-user, active-comparator, 1:1 propensity-matched design.
- Tirzepatide was associated with lower risks of: all-cause mortality, all-cause hospitalization, acute MI, and heart failure over 2 years.
- Neutral for MACE composite and ischemic stroke (directionally favorable but not statistically significant).
- MASLD patients with established CAD/HF or frequent admissions may see the most clinically meaningful benefit.
- Observational RWE—robust design, but not a randomized trial; apply shared decision-making (coverage, tolerability, comorbidities).
What do patients need to know?
If you have fatty liver (MASLD), type 2 diabetes, and obesity, tirzepatide may offer more protection than semaglutide against death, hospital stays, heart attacks, and heart-failure problems over about two years. Some outcomes (like stroke) looked similar between the medicines. This study compared thousands of patients treated in real clinics, which is powerful, but it wasn’t a randomized trial—so results don’t prove cause-and-effect for every person. Talk with your clinician about which option fits your health goals, other medicines, and insurance coverage.
Author Contact
Basil Jalamneh, MD
Cleveland Clinic Foundation
Cleveland, OH
basil.jal97 [at] gmail.com
For assistance contacting other ACG experts, please contact Becky Abel, ACG’s Senior Communications Manager, at mediaonly [at] gi.org.