Evidence synthesis · §3
Gastrointestinal adverse events with incretin receptor agonists — included and excluded studies
The included-studies table with extracted data, the exclusions with reasons, and the risk-of-bias judgements.
§3Included and excluded studies
Every study contributing to this review is listed below with the data extracted from it. The extraction table is published at the level of the individual outcome and study so that the synthesis can be checked without the reader having to retrieve each source.
§3.1Included studies
Table 4. Included studies with the characteristics extracted from each.
| Study | Design | Randomised | Duration | Anchor outcome as reported | Year |
|---|---|---|---|---|---|
| ACHIEVE-1Orforglipron | Randomised, double-blind, placebo-controlled | — | 40 weeks | no result held | 2025 |
| ACHIEVE-2Orforglipron | Randomised, double-blind, active-controlled | — | 52 weeks | no result held | 2025 |
| ATTAIN-1Orforglipron | Randomised, double-blind, placebo-controlled | — | 72 weeks | The Institute holds a headline result indicating a weight effect intermediate between the injectable single agonists and placebo, and awaits the full… | 2025 |
| ATTAIN-2Orforglipron | Randomised, double-blind, placebo-controlled | — | 72 weeks | no result held | 2025 |
| STRIDESemaglutide | Randomised, double-blind, placebo-controlled | 792 | 52 weeks | Estimated treatment ratio 1.13 (95 % CI 1.06 to 1.21) | 2025 |
| SURMOUNT-5Tirzepatide | Randomised, open-label, active-controlled | 751 | 72 weeks | Mean change −20.2 % with tirzepatide versus −13.7 % with semaglutide | 2025 |
| SURMOUNT-KOATirzepatide | Randomised, double-blind, placebo-controlled | — | 68 weeks | Improvement relative to placebo. The Institute records that pain improvement in a weight-loss trial cannot be attributed to a direct joint effect | 2025 |
| SURPASS-CVOTTirzepatide | Event-driven cardiovascular outcome trial | 13,299 | Median 4.5 years | Non-inferior to dulaglutide on the primary composite. The Institute records that an active-controlled non-inferiority design cannot establish superiority over… | 2025 |
| FLOWSemaglutide | Event-driven kidney outcome trial | 3,533 | Median 3.4 years | Hazard ratio 0.76 (95 % CI 0.66 to 0.88); annual eGFR slope difference 1.16 mL/min/1.73 m² per year | 2024 |
| STEP-HFpEF-DMSemaglutide | Randomised, double-blind, placebo-controlled | 616 | 52 weeks | Directionally consistent with STEP-HFpEF with a smaller weight effect, as expected in a population with diabetes | 2024 |
| SUMMITTirzepatide | Randomised, double-blind, placebo-controlled | 731 | Median 104 weeks | Hazard ratio 0.62 (95 % CI 0.41 to 0.95) for the composite; clinical summary score difference 6.9 points (95 % CI 3.3 to 10.6) | 2024 |
| SURMOUNT-4Tirzepatide | Randomised withdrawal | 670 | 52 weeks after a 36-week open-label lead-in | Continued treatment −5.5 % versus +14.0 % after switching to placebo | 2024 |
| SURMOUNT-OSA-1Tirzepatide | Randomised, double-blind, placebo-controlled | — | 52 weeks | Substantial reduction in the apnoea–hypopnoea index relative to placebo; the Institute reproduces the pooled programme estimate rather than a per-trial figure | 2024 |
| SURMOUNT-OSA-2Tirzepatide | Randomised, double-blind, placebo-controlled | — | 52 weeks | Directionally consistent with the companion trial | 2024 |
| DANU-PH2B-OBESITYDanuglipron | Randomised, double-blind, placebo-controlled | 605 | 32 weeks | Dose-dependent weight reduction accompanied by discontinuation rates above 50 % in some arms; development in obesity was subsequently discontinued | 2023 |
| DANU-PH2B-T2DDanuglipron | Randomised, double-blind, placebo-controlled | 411 | 16 weeks | Glycaemic effect demonstrated; the programme was discontinued for tolerability and hepatic-safety reasons | 2023 |
| ORFO-PH2-OBESITYOrforglipron | Randomised, double-blind, placebo-controlled | 272 | 36 weeks | Mean change up to −14.7 % versus −2.3 % with placebo | 2023 |
| ORFO-PH2-T2DOrforglipron | Randomised, double-blind, placebo-controlled | 383 | 26 weeks | Reduction of up to 2.1 percentage points versus 0.4 with placebo | 2023 |
| SELECTSemaglutide | Event-driven cardiovascular outcome trial | 17,604 | Mean 39.8 months | Hazard ratio 0.80 (95 % CI 0.72 to 0.90); 6.5 % versus 8.0 % | 2023 |
| STEP-HFpEFSemaglutide | Randomised, double-blind, placebo-controlled | 529 | 52 weeks | Clinical summary score improved 16.6 points versus 8.7 points with placebo; estimated difference 7.8 points (95 % CI 4.8 to 10.9) | 2023 |
| SURMOUNT-2Tirzepatide | Randomised, double-blind, placebo-controlled | 938 | 72 weeks | Mean change −14.7 % at 15 mg versus −3.2 % with placebo | 2023 |
| SURMOUNT-3Tirzepatide | Randomised, double-blind, placebo-controlled | 806 | 72 weeks after a 12-week lead-in | Additional mean change −18.4 % versus +2.5 % with placebo after the lead-in | 2023 |
| STEP-5Semaglutide | Randomised, double-blind, placebo-controlled | 304 | 104 weeks | Mean change −15.2 % versus −2.6 % with placebo; the longest randomised exposure in the programme | 2022 |
| STEP-8Semaglutide | Randomised, double-blind, active-controlled | 338 | 68 weeks | Mean change −15.8 % with semaglutide versus −6.4 % with liraglutide; difference −9.4 percentage points (95 % CI −12.0 to −6.8) | 2022 |
| 24 included studies. Each links to its structured abstract, which carries a field-by-field provenance table distinguishing extracted figures from Institute reconstructions. | |||||
Contributing participants across studies reporting a randomised total: 42,582. Studies for which the Institute does not hold a randomised total contribute to the qualitative synthesis and not to any pooled figure.
§3.2Excluded at full text, with reasons
Table 5. Reports excluded at full text, by reason. A review that reports an exclusion count without reasons cannot be checked against its own protocol.
| Reason for exclusion | Reports |
|---|---|
| Not a randomised comparison | 20 |
| Population outside the review question | 22 |
| Intervention outside the review question | 7 |
| Comparator not eligible | 8 |
| No eligible outcome reported | 13 |
| Duplicate report of an included study | 10 |
| Conference abstract without extractable data | 14 |
| Retracted or subject to an expression of concern | 17 |
| 82 reports excluded at full text in total. | |
§3.3Risk of bias across included studies
Table 6. Risk-of-bias judgement recorded for each included study on the review's anchor outcome.
| Study | Risk of bias | Inconsistency | Indirectness | Imprecision | Publication bias |
|---|---|---|---|---|---|
| ACHIEVE-1 | Some | Low | Low | Low | Some |
| ACHIEVE-2 | Low | Low | Some | Low | Some |
| ATTAIN-1 | Low | Low | Low | Some | Low |
| ATTAIN-2 | Low | Low | High | Low | Low |
| STRIDE | Low | Some | Low | Low | Low |
| SURMOUNT-5 | Low | Low | Low | Low | Low |
| SURMOUNT-KOA | Some | Low | Low | Low | Some |
| SURPASS-CVOT | Low | Some | Low | Low | Low |
| FLOW | Low | Low | Low | Low | Low |
| STEP-HFpEF-DM | Low | Low | Low | Low | Some |
| SUMMIT | Low | Low | Low | Low | Some |
| SURMOUNT-4 | Low | Low | Low | Low | Low |
| SURMOUNT-OSA-1 | Low | Low | Low | Low | Low |
| SURMOUNT-OSA-2 | Low | Low | Low | Low | Low |
| Judgements are the Institute's own and are recorded per outcome. A study may carry a different judgement in a different review that assesses a different outcome from it. | |||||
References cited on this page
References are numbered in order of first citation in this document. Each superscript in the text links to its entry below.
- Wilding JPH, Batterham RL, Calanna S, Davies M, Van Gaal LF, Lingvay I, McGowan BM, Rosenstock J, Tran MTD, Wadden TA, Wharton S, Yokote K, Zeuthen N, Kushner RF. Once-weekly semaglutide in adults with overweight or obesity. New England Journal of Medicine 2021;384(11):989–1002. doi:10.1056/NEJMoa2032183 · PMID 33567185
Identifiers are reproduced only where the Institute holds them. Where a digital object identifier or PubMed identifier is not shown, the Institute has recorded the journal and year and has not constructed an identifier.
Compound Evidence Institute · CEI-ES-005/3 · https://compoundevidence.com/syntheses/gastrointestinal-tolerability-incretins/included-studies/ · retrieved 30 July 2026