Tirzepatide Outperforms Dulaglutide in Cardiorenal Outcomes, With Steven Nissen, MD

Tirzepatide treatment resulted in a substantial reduction in a broad 6-component composite of cardiovascular and kidney endpoints compared to dulaglutide, according to a post hoc analysis of the SURPASS-CVOT trial.

American College of Cardiology (ACC) Scientific Sessions 2026

 in New Orleans, Louisiana, by Steven Nissen, MD, chief academic officer of the Heart and Vascular Institute at the Cleveland Clinic and professor of medicine at the Lerner College of Medicine.

“What this tells us is that targeting 2 incretins, which is what tirzepatide does, is actually a better strategy in terms of reducing major morbidity and mortality than just targeting GLP-1 alone,” Nissen told 

 in an exclusive interview. “We’re moving beyond the simple GLP-1 agonists – we’re moving to these more complex therapies that involve targeting more than 1 of the gut hormones.”

SURPASS-CVOT was an active-comparator-controlled, double-blind, noninferiority trial comparing tirzepatide and dulaglutide for cardiovascular outcomes in patients with 

atherosclerotic cardiovascular disease (ASCVD)

. Patients were eligible if they were ≥40 years old with T2D, a glycated hemoglobin level between 7% and 10.5%, a body mass index (BMI) of ≥25, and established ASCVD. Patients were excluded if they had any cardiovascular event within 60 days before screening, had used a GLP-1 RA within 3 months before screening, or had chronic advanced 

Eligible patients were randomized in a 1:1 ratio to either weekly subcutaneous tirzepatide 15 mg or dulaglutide 1.5 mg. Patients were monitored at trial visits every 4 weeks for the first 24 weeks and every 3 months thereafter. A total of 6586 patients entered the tirzepatide arm and 6579 entered the dulaglutide arm. The primary endpoint was a composite of cardiovascular mortality, myocardial infarction, or stroke.

Among the 13,165 patients enrolled in the original trial, the mean age was 64 years (standard deviation [SD], 8.8), and mean hemoglobin A1c was 8.4% (SD, 0.93). A primary endpoint event occurred in 801 patients (12.2%) in the tirzepatide arm and 862 (13.1%) in the dulaglutide arm. Adverse event incidence was similar between the 2 groups, although tirzepatide recipients saw more gastrointestinal adverse events.

In the present analysis, Nissen and colleagues crafted an additional primary endpoint composed of 6 potential events, including all-cause mortality, myocardial infarction, stroke, coronary revascularization, hospitalization for heart failure, and a composite of several adverse kidney outcomes.

This 6-point composite endpoint occurred in 1559 patients (23.7%) receiving tirzepatide and 1803 patients (27.4%) receiving dulaglutide (HR, 0.84; 95% CI, 0.79-0.9; 

 <.001) after a median treatment duration of 46.9 months (interquartile range [IQR], 34.6-50.6). Sensitivity analyses showed similar hazard ratios for a 5-component endpoint excluding kidney outcomes (HR, 0.86; 95% CI, 0.8-0.93).

Nissen noted the limited structure of the trial, given its status as a post hoc analysis. Tirzepatide’s explicit superiority in this particular patient cohort cannot be assumed based on these data.

“It’s important to remember that this is a secondary analysis of a trial,” Nissen said. “I happen to be the chair of the study SURMOUNT-MMO, which is studying tirzepatide compared to placebo in both primary and secondary prevention patients without diabetes. We’ll find out in a much broader population whether targeting with a dual incretin therapy really is superior to placebo.”

Editors’ Note: Nissen reports disclosures with Amgen, AstraZeneca, Bristol Myers Squibb, Novartis, Medtronic, Eli Lilly, and others.

Nissen SE, Wolski K, D’Alessio D, et al. Cardiorenal Outcomes With Tirzepatide Compared With Dulaglutide in Patients With Diabetes and Cardiovascular Disease: A Post Hoc Analysis of the SURPASS-CVOT Randomized Clinical Trial. 

. March 28, 2026. Accessed April 10, 2026. 

Nicholls SJ, Pavo I, Bhatt DL, et al. Cardiovascular outcomes with Tirzepatide versus dulaglutide in type 2 diabetes. 

Videos

Nissen discusses his post-hoc analysis of the SURPASS-CVOT trial, comparing the 2 drugs for a 6-component composite endpoint of cardiorenal outcomes.

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Cardiology condition center page is a comprehensive resource for clinical news and insights on cardiovascular and cardiometabolic diseases. This page consists of interviews, articles, podcasts, and videos on the research, treatment and development of therapies for heart disease and cardiovascular events, as well as associated diabetes, renal failure, and more...

Atherosclerotic Cardiovascular Disease

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Strategic Alliance Partnership

Michael H. Gold, MD, is the founder and medical director of Gold Skin Care Center, Advanced Aesthetics Medical Spa, The Laser & Rejuvenation Center.

How to Deal With Cosmetic Complications in Dermatology, With Michael H. Gold, MD

 practice, cosmetic procedures have become an increasingly central element, with energy-based devices and other aesthetic interventions now being used routinely in a wide array of clinical settings.

However, dermatology clinicians know complications occur, even in the most experienced hands. A session, titled ‘Complications of Cosmetic Procedures,' was presented at the 

2026 American Academy of Dermatology (AAD) Annual Meeting

 by several speakers, including Michael H. Gold, MD, the founder and medical director of Gold Skin Care Center, Advanced Aesthetics Medical Spa, & The Laser & Rejuvenation Center.

“Everybody will see a complication,” Gold explained. “If you don't, the old adage is you haven't done enough. The issue is understanding that it is a complication early, working with the patient to make sure they understand you know what you're doing, and coming up with a solution that makes it get better fast.”

Gold described complications as not a matter of if, but when. His core message throughout his session was that the ability to recognize a complication early, communicate openly with those involved, and to move quickly toward a solution is what separates a manageable setback from a lasting problem. He described the vast majority of complications are reversible when approached properly.

Throughout his talk, Gold drew on his 35-plus years of experience, sharing a variety of examples from cases in both his own practice and colleagues with whom he runs complication panels throughout the year. Intense pulsed light (IPL) was highlighted as 1 unique focus. Gold described newer machines as having diminished the incidence of burns, blistering, and shifts in pigment, yet he added that the risks have not been eliminated completely.

Additionally, Gold cautioned clinicians in the dermatology space against cutting corners on device quality, describing less expensive machines as often less rigorously assessed. He also touched on the medical-legal dimensions of complication management, noting clinicians should consider informed consent, detailed documentation, and pre-procedure photography as essential.

For any additional information on complications, view the full video interview from AAD 2026 posted above.

The quotes contained in this interview summary were edited for clarity.

Gold reports relationships with multiple companies, including roles as a consultant (honoraria) for Acclaro Medical, Aesthetic Management Partners, Aesthetics Biomedical, Alastin Skincare, Inc., Allergan, Inc., Benev, Galderma, Hugel, InMode, La Mer, Mindera, MTF Biologics, Nutrafol, Pierre Fabre, Prescriber’s Choice, Revision Skincare, Rohrer Aesthetics, Sciton Inc., Sensus Healthcare, Sente Labs, SkinBetter Science, SkinCeuticals LLC, SkinMedica, Inc., Sofwave, Stratapharma, and VIOL. He has served as a speaker (honoraria) for Alma Lasers, Cutera, Inc., EndyMed Medical Inc. USA, Lumenis, Merz Pharmaceuticals, LLC, and Venus Concept. He is an investigator (grants/research funding) for Bausch Health, Leo Pharma Inc., Revance Therapeutics, Inc., Revision Skincare, and SkinBetter Science. He also reports stockholder status with Aerolase and stock options with Venus Concept.

Perez SM, Kennedy DJ, Landau M, et al. Implications of Dermatologic Disorders in Facial Cosmetic Surgery: A Systematic Review. Ann Plast Surg. 2026 May 1;96(5):404-412. doi: 10.1097/SAP.0000000000004731. Epub 2026 Mar 19. PMID: 41848703.

Gold M, et al. S051 Complications of Cosmetic Procedures. Session presented at: 2026 American Academy of Dermatology Annual Meeting; March 27–31, 2026; Denver, CO.

During this video interview at AAD 2026, Gold touches on key points made in his session titled ‘Complications of Cosmetic Procedures.’

Dermatology

The HCPLive dermatology page is a resource for medical news and expert insights on skin disease. This page features expert-led coverage, articles, videos and research on the therapies and development of treatments for dermatologic conditions, and more.

TETON-2 Supports Antifibrotic Benefit of Inhaled Treprostinil in IPF, With Steven Nathan, MD

Inhaled treprostinil (Tyvaso; United Therapeutics) significantly preserved lung function and reduced the risk of clinical worsening compared with placebo over 52 weeks in patients with idiopathic pulmonary fibrosis (IPF) — findings that Steven D. Nathan, MD, FCCP, argues position the drug as a first inhaled antifibrotic therapy and validate a years-long hypothesis derived from an earlier pulmonary hypertension trial.

Nathan, medical director of the Advanced Lung Disease and Lung Transplant Program at Inova Fairfax Hospital in Falls Church, Virginia, and chair of the TETON steering committee, was the presenting author of the TETON-2 results at the European Respiratory Society meeting in Amsterdam in September 2025., and later the full paper published in the 

spoke with Nathan to learn more about TETON-2, a phase 3, multicenter, randomized, double-blind, placebo-controlled trial enrolling 593 patients with IPF across sites in Asia-Pacific, Europe, and Latin America. Patients in the trial were randomly assigned 1:1 to receive nebulized treprostinil or placebo, titrated from 3 breaths 4 times daily to a target regimen of 12 breaths 4 times daily over 52 weeks. The mean patient age was 71.7 years, 80.1% were men, mean baseline forced vital capacity (FVC) was 76.8% predicted, and 75.4% were receiving background antifibrotic therapy with nintedanib or pirfenidone.

The trial met its primary endpoint: the median change in absolute FVC at week 52 was −49.9 mL (95% CI, −79.2 to −19.5) in the treprostinil group versus −136.4 mL (95% CI, −172.5 to −104.0) in the placebo group, yielding a between-group difference of 95.6 mL (95% CI, 52.2 to 139.0; 

 <.001). Treprostinil also significantly reduced the risk of clinical worsening, with events occurring in 81 patients (27.2%) in the treprostinil group versus 115 (39.0%) in the placebo group (hazard ratio, 0.71; 95% CI, 0.53 to 0.95; 

 = .02), a 29% risk reduction. These benefits were observed across all analyzed subgroups, including patients with and without background antifibrotic therapy, across smoking histories, and in those using supplemental oxygen. No substantial between-group difference in time to acute IPF exacerbation was observed, precluding formal inference on subsequent prespecified secondary endpoints per the hierarchical testing procedure. The most common adverse event was cough, reported in 48.3% of treprostinil-treated patients versus 24.1% of those receiving placebo; the overall safety profile was consistent with prior Tyvaso experience and known prostacyclin-related adverse events, with no new safety signals identified.

Nathan described the conceptual underpinning of the TETON program as originating from an ad hoc analysis of the INCREASE trial — a phase 3 study of inhaled treprostinil in pulmonary hypertension associated with interstitial lung disease (PH-ILD), published in the 

 in March 2021, which supported the drug's approval for that indication. Although FVC was assessed in INCREASE as a safety measure rather than an efficacy endpoint, patients who received inhaled treprostinil demonstrated better lung function at week 16 than those on placebo, and patients who crossed over to open-label treprostinil from placebo showed subsequent FVC gains — a signal Nathan characterized as suggesting independent antifibrotic properties beyond vasodilation. That hypothesis became the foundation for the TETON program, which also includes a third study, TETON-PPF, evaluating inhaled treprostinil in progressive pulmonary fibrosis beyond IPF.

TETON-1, the North American sister study enrolling 598 patients in the United States and Canada, reported positive topline results in March 2026, with treprostinil demonstrating superiority over placebo for absolute FVC change from baseline to week 52 by 130.1 mL (Hodges-Lehmann estimate, 95% CI, 82.2 to 178.1 mL; 

 <.0001) — a treatment effect exceeding that observed in TETON-2. TETON-1 also achieved statistical significance for reducing the risk of clinical worsening. United Therapeutics plans to submit a supplemental New Drug Application to the FDA by the end of summer 2026 seeking to add IPF to the labeled indications for nebulized Tyvaso, with integrated analyses of both TETON studies to be presented at the American Thoracic Society Annual Meeting in Orlando in May 2026.

“In fact, when the placebo arm got converted to open label with treprostinil, the FVCs went up. So this gave us some kind of indication that maybe treprostinil had independent anti fibrotic properties, and that was the foundation and underpinning for the TETON program,” Nathan said.

Nathan’s reported disclosures include AstraZeneca, Avalyn Pharma, Boehringer Ingelheim, Pliant, and United Therapeutics.

Nathan SD, Smith P, Deng C, et al; TETON-2 Trial Investigators. Inhaled treprostinil for idiopathic pulmonary fibrosis. 

. Published online March 11, 2026. doi:10.1056/NEJMoa2512911

United Therapeutics Corporation. United Therapeutics Corporation announces TETON-1 pivotal study of Tyvaso® meets primary endpoint for treatment of idiopathic pulmonary fibrosis, exceeding impressive treatment effect seen in TETON-2. Press release. March 30, 2026. Accessed April 10, 2026. 

https://ir.unither.com/press-releases/2026/03-30-2026-120037465

Treprostinil significantly slowed FVC decline and reduced clinical worsening events over 52 weeks in patients with IPF.


Pulmonology

Infectious Disease condition center page is a comprehensive resource for clinical news and insights on respiratory health. This page consists of interviews, articles, podcasts, and videos on the research, treatment and development of therapies for asthma, COPD, interstitial lung disease, COVID-19, and more.

Pulmonary Fibrosis

Eingun James Song, MD, is the director of clinical research for Frontier Dermatology. 

Linda Stein Gold, MD, is a dermatologist at Henry Ford Health. 

In this episode, ‘Redefining Treatment Success in Psoriasis,’ the expert dermatologists explore the remarkable evolution of treatment expectations in psoriasis, moving from modest improvements to ambitious goals of complete skin clearance and sustained remission. The faculty reflect that in earlier treatment paradigms even a 50% improvement in disease severity was considered a meaningful success. 

Redefining Treatment Success in Psoriasis

In this episode, ‘Redefining Treatment Success in Psoriasis,’ the expert dermatologists explorethe remarkable evolution of treatment expectations in psoriasis, moving from modest improvements to ambitious goals of complete skin clearance and sustained remission. The faculty reflect that in earlier treatment paradigms even a 50% improvement in disease severity was considered a meaningful success.

As advances in immunology and targeted biologic therapies have transformed the treatment landscape, expectations have shifted dramatically. Clinicians now have a deeper understanding of the underlying inflammatory pathways driving psoriasis, enabling the development of therapies that can deliver high levels of skin clearance with improved safety profiles. As a result, conversations with patients have evolved, with many now expecting near-complete or complete resolution of their disease.

The panelists also discussed the National Psoriasis Foundation consensus definition of on-treatment remission, representing an important step toward aligning clinical goals with patient-centered outcomes. The faculty examine the rationale for establishing a formal definition, emphasizing the importance of setting clear, achievable targets that reflect both clinical efficacy and quality of life. By incorporating perspectives from clinicians, patients, and other stakeholders, this definition underscores a broader shift in psoriasis care toward sustained disease control and meaningful remission. Overall, this discussion reinforces how far the field has progressed and sets the stage for applying these elevated expectations in clinical practice.

The next episode in this series, ‘Remission as a Goal in Psoriasis,’ features the panelists examining the clinical relevance of achieving and sustaining remission in psoriasis, emphasizing that ambitious treatment goals are increasingly attainable with modern therapies. It highlights the importance of maintaining disease control over time while aligning treatment strategies with patient quality of life and long-term outcomes.

Video Series

Redefining Treatment Success in Psoriasis April 2026

Welcome back to another HCP Live Peer Exchange series. In this episode titled, ‘Evolving Treatment Expectations in Psoriasis,’ the panelists discussed how treatment goals in psoriasis have evolved alongside advances in therapeutic innovation and disease understanding. The expert faculty began by reflecting on the historical limitations of traditional therapies, including topicals, phototherapy, and early systemic agents, which were often insufficient for achieving sustained disease control. In earlier eras, treatment success was defined and accepted by improvement rather than complete clearance of the skin. 

Evolving Treatment Expectations in Psoriasis

Welcome back to another HCP Live Peer Exchange series. In this episode titled, ‘Evolving Treatment Expectations in Psoriasis,’ the panelists discussed how treatment goals in psoriasis have evolved alongside advances in therapeutic innovation and disease understanding. The expert faculty began by reflecting on the historical limitations of traditional therapies, including topicals, phototherapy, and early systemic agents, which were often insufficient for achieving sustained disease control. In earlier eras, treatment success was defined and accepted by improvement rather than complete clearance of the skin.

As the conversation progresses, the panel highlighted how the advent of biologic therapies has fundamentally reshaped expectations for both clinicians and patients. With increasing insights into psoriasis pathophysiology, particularly the role of targeted cytokine pathways, modern treatments have enabled deeper and more durable responses. This has shifted the paradigm from partial improvement to ambitious goals such as near complete or complete skin clearance.

The panelists introduce the concept of drug remission as an emerging clinical objective. The faculty discussed how advances in precision medicine have not only improved efficacy but also enhanced safety profiles, allowing clinicians to pursue sustained disease control with greater confidence. The discussion emphasized how these developments have transformed patient-provider conversations, with patients now expecting high levels of clearance without significant trade-offs in safety.

In the next episode, ‘Redefining Treatment Success in Psoriasis’, panelists will highlight how treatment expectations in psoriasis have evolved from modest improvements to achieving complete clearance and sustained remission. It will also introduce the National Psoriasis Foundation definition of on-treatment remission and its implications for aligning clinical goals with patient-centered outcomes.

Clara Bohm, MD, is a nephrologist and associate professor in the Department of Internal Medicine at the University of Manitoba. 

A multicenter RCT of intradialytic cycling showed a modest, nonsignificant reduction in myocardial stunning in hemodialysis patients.

Nephrology

The HCPLive nephrology page is a resource for medical news and expert insights on kidney disease. This page features expert-led coverage, articles, videos and research on the therapies and development of treatments in nephrology, and more.

Intradialytic Cycling Does Not Significantly Reduce Myocardial Stunning in Hemodialysis Patients

Mercedes Martinez, MD, is a professor of pediatrics and medicine, medical director of the intestinal transplant program at the Center for Liver Disease and Abdominal Organ Transplantation, and medical director of the pediatric abdominal organ transplantation program at NewYork-Presbyterian.

Martinez describes how IBAT inhibitors are reshaping cholestatic pruritus care, with impacts on symptoms, growth, and long-term liver outcomes.

Hepatology

Cholangitis

cholangitis page, resources on the topics of medical news and expert insight into cholangitis can be found. Content includes articles, interviews, videos, podcasts, and breaking news on research, treatment, and drug development in PBC, PSC, and more!

Optimizing Cholestatic Disease Care With IBAT Inhibitors, With Mercedes Martinez, MD

Tim Smith joined the MJH Life Sciences team in 2022 and is currently an associate editor for HCPLive. He is also the executive producer of two podcasts: Skin of Color Savvy and The Medical Sisterhood. Previously, he was the producer of the Lungcast podcast. He graduated from UC Berkeley and worked in multimedia journalism as a staff writer prior to joining MJH. You can contact him at tsmith@mjhlifesciences.com.

Articles

These new dermatology guidelines represent the first-ever atopic dermatitis-centered guidelines for pediatric patients issued by the AAD.

Atopic Dermatitis

Atopic Dermatitis condition center page, audiences can find a variety of coverage mediums for medical news and updates, including articles, video interviews, podcasts, and breaking news on dermatitis research, treatment, and drug development.

First-Ever Pediatric Eczema Guidelines Issued by American Academy of Dermatology

This review of dermatology news from the first quarter of 2026 highlights key headlines, FDA news, and more.

Plaque Psoriasis

The HCPLive plaque psoriasis page is a resource for medical news and expert insights on psoriasis. This page features expert-led coverage, articles, videos and research on the therapies and development of treatments for psoriatic disease, and more.

Q1 2026 Recap: Dermatology News and Updates

Dominic Sisti, PhD, is an associate professor in the Department of Medical Ethics & Health Policy and the director of the Scattergood Program for the Applied Ethics of Behavioral Health Care. Sisti is also the host of 

, our monthly multimedia series on medical ethics in modern healthcare. 

Sisti discusses ethics, safety, and guardrails as patients use ChatGPT for mental health support and clinicians navigate AI’s role in psychiatry.

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AI in Psychiatry Raises Ethics Questions With Dominic Sisti, PhD

Aaron Troy, MD, MPH, is a clinical research fellow in cardiovascular medicine at Johns Hopkins Hospital and Johns Hopkins Bayview Medical Center.

Troy discusses the recent changes to the ABCs of CVD, highlighting an increased focus on lifestyle interventions and the management of risk factors.

Heart Failure

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Arrhythmia

Reviewing the Updated ABCs of Cardiovascular Disease Prevention, With Aaron Troy, MD, MPH

Simon Davies, MD, is  a consultant nephrologist at the University Hospital of North Midlands and Professor of Nephrology and Dialysis Medicine, as well as director of the Institute for Applied Clinical Sciences at Keele University.

Davies explains the future of at-home dialysis access, including policy changes and technological innovation. 

Chronic Kidney Disease

Expanding Dialysis Access: Policy, Variation, and the Role of Peritoneal Dialysis

Nancy Reau, MD, is Professor of Internal Medicine, Richard B. Capps Chair of Hepatology, Associate Director of Solid Organ Transplantation, and Section Chief of Hepatology at Rush University Medical Center.

Experts discuss interpreting genetic testing in liver disease, the role of biopsy, and how to integrate variants into clinical decision-making.

Putting the Pieces Together: Genetic Testing, Biopsy, and Clinical Judgment

Nicole Chase, MD, is a board-certified allergist/immunologist at St. Paul Allergy Asthma, Minneapolis VA Health Care System (part-time), and an associate professor of medicine at the University of Minnesota Medical School.

Chase discusses how the FDA’s labeling change aligns epinephrine nasal spray (neffy) with other weight-based epinephrine formulations.

Allergy

Allergy condition center page is a comprehensive resource for clinical news and insights on allergic and inflammatory diseases. This page consists of interviews, articles, podcasts, and videos on the research, treatment and development of therapies for food and seasonal allergies, as well as allergic asthma and related conditions.

Anaphylaxis

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Weight-Based Dosing Informs Age Removal for Epinephrine Nasal Spray, With Nicole Chase, MD

Alberico Catapano, PhD, is the research director and head of the laboratory of lipoproteins and atherosclerosis and of the lipid clinic at MultiMedica IRCCS.

Catapano discusses the superior reduction in LDL-C, ApoB, and non-HDL-C demonstrated by enlicitide, suggesting its role as an add-on for LDL-C lowering.

Latest News

Tirzepatide Outperforms Dulaglutide in Cardiorenal Outcomes, With Steven Nissen, MD

How to Deal With Cosmetic Complications in Dermatology, With Michael H. Gold, MD

TETON-2 Supports Antifibrotic Benefit of Inhaled Treprostinil in IPF, With Steven Nathan, MD

Redefining Treatment Success in Psoriasis April 2026

Evolving Treatment Expectations in Psoriasis