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ForumsMASH / Liver DiseaseSurvodutide SYNCHRONIZE Phase 3 — MASH primary endpoint design

Survodutide SYNCHRONIZE Phase 3 — MASH primary endpoint design

TrialTracker_MD Wed, Jun 3, 2026 at 1:57 PM 3 replies 228 viewsPage 1 of 1
TrialTracker_MD
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Jun 3, 2026 at 1:57 PM#1

Watching the glucagon co-agonists for the liver endpoints and finding almost nothing written about them that is not a press release.

The bit I cannot resolve on my own is whether the liver signal is independent of weight loss or downstream of it, because that determines whether any of this is interesting for someone whose weight is already where they want it.

Numbers rather than impressions, if you have them.

8 3Dr.EM_Chicago, pete_RVA, CarlaRPh_TPA and 5 others
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LarryQC_SD
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Jun 3, 2026 at 2:29 PM#2

This one has a reasonably settled answer, so here it is. Read four things before the headline number. The population, because trial populations are selected and supported in ways that real cohorts are not. The comparator, because "better than placebo" and "better than the current standard" are different claims and get reported identically. The primary endpoint as pre-registered, because a secondary endpoint promoted after the fact is a hypothesis rather than a finding. And the completion rate, because a large effect in the half of participants who finished is a different result from a large effect in everybody enrolled.

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HPLC_Greg
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Jun 3, 2026 at 3:01 PM#3
LarryQC_SD said:
Read four things before the headline number.

Agreed, and subgroup analyses deserve particular suspicion. With enough subgroups something is significant by chance, and pre-registered subgroups are a different animal from ones found afterwards.

Last edited: Jun 3, 2026 at 9:01 PM
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AttorneyGrant
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Jun 3, 2026 at 3:33 PM#4
TrialTracker_MD said:
Watching the glucagon co-agonists for the liver endpoints and finding almost nothing written about them that is not a press release.

This is my experience too, for whatever a second data point is worth. Nothing to add that would improve it.

Last edited: Jun 3, 2026 at 4:33 PM
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CarlaRPh_TPA
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Jun 3, 2026 at 6:30 PM#5

From the other side of the consultation, briefly.

Glucagon receptor pharmacology in triple agonists (retatrutide), relevant to the glucagon co-agonists: the glucagon component is the most controversial because glucagon traditionally raises blood glucose. So why include it in an anti-obesity drug?

Key insight: glucagon increases energy expenditure (thermogenesis), promotes hepatic lipid oxidation, and reduces appetite through distinct CNS mechanisms. The hyperglycemic effect is counterbalanced by the GLP-1 component's insulin secretagogue action.

Net result: more weight loss through increased expenditure (glucagon) + decreased intake (GLP-1/GIP), with neutral or improved glycemia. An elegant pharmacological balancing act[1].

References:
[1] Day JW, et al. Nat Rev Drug Discov. 2022;21:37-54.
Last edited: Jun 3, 2026 at 10:30 PM
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