SURMOUNT-5: Tirzepatide vs semaglutide head-to-head — November 2025

For what it's worth, there was a retrospective analysis (Rubino et al., presented at ObesityWeek 2024) looking at patients who switched from semaglutide to tirzepatide. The cohort that did accelerated titration (2wk/2wk through starter doses) had comparable GI adverse event rates to the standard titration group. N was small though (~180 patients).

The more interesting finding was that 73% of sema "plateau" patients resumed weight loss within 8 weeks of reaching tirz 7.5mg or higher.

following this thread! im in the exact same boat. stalled on wegovy 2.4 for almost 4 months now 😩

quinn_sf said:

For what it's worth, there was a retrospective analysis (Rubino et al., presented at ObesityWeek 2024) looking at patients who switched from semagluti…

73% resumed weight loss — that tracks with what I've seen anecdotally on here and on the Discord. The other 27% probably needed 10mg+. Have you seen any data on what happens to that remaining group at higher tirz doses?

UPDATE — Week 2:

Ok so I'm finishing my second week on 2.5mg and here's what I'm noticing:

• Appetite suppression is milder than what I had on Wegovy, but it's... different? Hard to explain but food doesn't look as "exciting" if that makes sense
• Zero nausea so far (I had horrible nausea on sema for the first 2 months)
• Energy is UP. Like noticeably. I thought people were exaggerating about the tirz energy boost but no, it's real
• Down 2.1 lbs already after 4 months of nothing on sema
• No sulfur burps yet 🤞

Moving to 5mg next week per my endo's accelerated plan. Will keep updating!

SW: 247 | CW: 206.9 | GW: 165

The energy increase you're describing is something I hear from probably 60% of my patients who switch. There's some mechanistic basis for it — GIP receptor activation in the brain may have distinct effects on perceived energy vs pure GLP-1 agonism. It's not well studied yet but it's a very consistent patient-reported outcome.

Glad the transition is going smoothly! 🙌