Regulatory Milestones 2022 (May) : FDA approval of Mounjaro for type 2 diabetes (5, 10, 15 mg doses) 2023 (November) : FDA approval of Zepbound for chronic weight management (same molecule, obesity-specific branding) 2024 : EMA approval in European Union for both indications 2025 : SURPASS-CVOT cardiovascular outcomes data published, showing MACE benefit Molecular Structure and Chemistry Amino Acid Sequence Tirzepatide is a 39-amino acid peptide based on native human GIP(1-42) with multiple modifications: Modified sequence : Tyr-Aib-Glu-Gly-Thr-Phe-Thr-Ser-Asp-Tyr-Ser-Ile-Leu-Asp-Lys-Ile-Ala-Gln-Lys-Lys*(C-20 diacid via Glu-2xOEG)-Ala-Phe-Val-Gln-Trp-Leu-Ile-Ala-Gly-Gly-Pro-Ser-Ser-Gly-Ala-Pro-Pro-Pro-Ser-NH 2 Single-letter code : Y- Aib -E-G-T-F-T-S-D-Y-S-I- L -D-K-I-A-Q- K K *- A -F-V-Q-W-L-I-A-G-G-P-S-S-G-A-P-P-P-S-NH 2 Where bold indicates non-native substitutions vs
References: Biaggioni I (2024): Adrenoceptor Agonists & Sympathomimetic Drugs (Chapter 9)
Suspicious lesions, including lesions showing progressive change, should be biopsied
It is based on the 2026 NICE fertility guideline (NG257), the position of the Human Fertilisation and Embryology Authority (HFEA) on treatment add-ons, routine NHS preconception advice, and the largest evidence reviews available
Diabetes 122 (06), 368372
doi: 10.1186/s13048-016-0245-8
