PeptideStack
5.2kquestions
20kanswers
220users

Is SURMOUNT-3 a fair comparison of ecnoglutide against its comparator arm?

Asked 15 Mar 2026Modified 4 months agoViewed 5.9k times
This question was marked as a duplicate of Is TRIUMPH-1 a fair comparison of dulaglutide against its comparator arm?Closed 26 Mar 2026. It remains here because the answers below are specific to how it was asked.
20

For reference: SURMOUNT-3 · ecnoglutide.

I would like to know whether this claim survives contact with evidence.

If the answer is "nobody has tested that", I would like that stated so I can stop looking.

How well supported is this claim?

clinical-trials
clinical-trials

Reading the primary literature properly: estimands, intention-to-treat versus per-protocol, confidence intervals, absolute versus relative…

913 questions
semaglutide
semaglutide

A GLP-1 receptor agonist with a fatty-acid-acylated backbone and a roughly one-week half-life, marketed for type 2 diabetes and for weight…

360 questions
tirzepatide
tirzepatide

A dual GIP and GLP-1 receptor agonist. Questions here cover the SURPASS and SURMOUNT programmes, the practical differences from a pure GLP-1…

162 questions
shareeditfollowflag
SF
askedsasha_ferreira15k1615 Mar 2026

1 Answer

Accepted answer first, then by votes
54

Accepted answer

Start with the population. The inclusion criteria of the trial determine what its result can be extrapolated to, and the extrapolation people want is usually to a population the trial excluded.

The rodent thyroid C-cell findings that generated the labelled warning appear to be species-specific: rodent C-cells express GLP-1 receptors at high density, human C-cells at very low density, and human calcitonin data across large trial populations has not reproduced the signal. A family history of medullary thyroid carcinoma or MEN2 is nonetheless a genuine contraindication rather than a theoretical one.

Relative to absolute, worked

QuantityValueDerivation
Control-arm event rate8.0 %From the trial table, not the abstract
Hazard ratio0.80Reported
Treated event rate6.4 %8.0 × 0.80
Absolute risk reduction1.6 pp8.0 − 6.4
Number needed to treat631 ÷ 0.016
Relative risk reduction20 %1 − 0.80

The last two rows describe the same finding. Only one of them is used in headlines.

Liver enzymes are a poor surrogate for hepatic histology in both directions: substantial steatohepatitis with normal transaminases is common, and modest enzyme elevation with minimal fibrosis is common. If the question is fibrosis, the answer comes from a non-invasive score such as FIB-4 or a stiffness measurement, not from ALT.

SUSTAIN 6 was the original cardiovascular outcomes trial for semaglutide in type 2 diabetes and is the reference point for the class effect that SELECT later extended to a non-diabetic population[1].

Read the confidence interval, read the estimand, and compute the absolute effect yourself. It takes two minutes and it changes how the result feels.

shareimprove this answerflag
LD
answered · acceptedloss_on_drying47k13819 Mar 2026
Sponsored

PeptideMeter - Independent Peptide Analytics

Aggregated, published test results and vendor ratings built from submitted batches. Methodology stated, dataset browsable, no listing fees.

Browse results

Your answer

Ask PeptideStack is a static archive. Posting is closed, but the norms are worth stating: answer the question that was asked, show your working, cite the trial or the certificate, and say plainly where the evidence runs out.

Not medical advice. Research-use-only compounds are not approved for human use.