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Tier 1: Pure GLP-1, injectable, FDA-approved Exenatide (Byetta, Bydureon) Liraglutide (Victoza, Saxenda) Lixisenatide (Adlyxin) Dulaglutide (Trulicity) Semaglutide (Ozempic, Wegovy) Efpeglenatide (Eperzan) Tier 2: Pure GLP-1, oral, FDA-approved Semaglutide (Rybelsus) Orforglipron (Orfoglip) Tier 3: Dual or triple agonist, FDA-approved Tirzepatide (Mounjaro, Zepbound) Retatrutide (Retara) Tier 4: Compounded (not FDA-approved) Compounded semaglutide Compounded tirzepatide Compounded semaglutide + B12 Compounded tirzepatide + B12 The tier system reflects regulatory status, not efficacy
In the head-to-head SURMOUNT-5 trial (NEJM 2025), tirzepatide produced 20.2% weight loss vs 13.7% for semaglutide
Does genetic support for a target increase drug success rates 23
It is generally painless, but is usually irreversible
doi: 10.1097/PRS.0000000000009673
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