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Comparative Study
. 2025 Jun;27(6):3357-3366.
doi: 10.1111/dom.16353. Epub 2025 Mar 20.

Comparing clinical outcomes of adults with obesity receiving tirzepatide versus bariatric metabolic surgery: A multi-institutional propensity score-matched study

Jheng-Yan Wu  1   2 , Song-En Chan  3 , Wan-Hsuan Hsu  3 , Chia-Chih Kuo  3 , Ya-Wen Tsai  4 , Ting-Hui Liu  5 , Po-Yu Huang  3 , Min-Hsiang Chuang  3 , Tsung Yu  2 , Chih-Cheng Lai  6   7
Affiliations
Comparative Study

Comparing clinical outcomes of adults with obesity receiving tirzepatide versus bariatric metabolic surgery: A multi-institutional propensity score-matched study

Jheng-Yan Wu et al. Diabetes Obes Metab. 2025 Jun.

Abstract

Aims: This real-world study compared clinical outcomes between tirzepatide treatment and bariatric metabolic surgery (BMS) in adults with obesity.

Methods: This retrospective cohort study used the TriNetX network to identify adults with a body mass index (BMI) ≥ 30 kg/m2. Patients initiating tirzepatide treatment were compared with those undergoing BMS. The primary outcome was all-cause mortality, while secondary outcomes included major adverse cardiovascular events (MACEs) and major adverse kidney events (MAKEs). Hazard ratios (HRs) with 95% confidence intervals (CIs) were calculated, and stratified analyses were performed based on age, sex and BMI categories.

Results: After exclusions and 1:1 propensity score matching (PSM), 84 884 matched pairs were analysed. The incidence of all-cause mortality was 0.19 per 100 person-years in the tirzepatide group compared with 0.57 in the BMS group. Tirzepatide was associated with a significantly lower risk of all-cause mortality compared with BMS (HR, 0.311; 95% CI, 0.257-0.375; p < 0.0001). The mortality benefits were consistent across age groups, genders and BMI categories. Tirzepatide also reduced the risk of MACEs (HR, 0.743; 95% CI, 0.673-0.821; p < 0.0001) and MAKEs (HR, 0.375; 95% CI, 0.336-0.419; p < 0.0001). Stratified analyses demonstrated significant reductions in primary and secondary outcomes across most categories.

Conclusion: Tirzepatide demonstrated superior clinical outcomes compared with BMS in adults with obesity, including significant reductions in all-cause mortality, MACEs and MAKEs. These findings suggest that tirzepatide may serve as an effective non-surgical alternative to BMS, with broad applicability across diverse patient populations.

Keywords: bariatric metabolic surgery; cardiovascular outcomes; kidney outcomes; obesity; real‐world study; tirzepatide.

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References

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