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Compound monograph · evidence extract

Tirzepatide in obstructive sleep apnoea with obesity — evidence extract

The Institute's graded assessment of Tirzepatide for obstructive sleep apnoea with obesity, with the contributing trials and the domain-by-domain certainty reasoning.

Document identifier
CEI-MN-003/EV-OSA
Series
Evidence extract
Version
4.2
Published
16 Jan 2024
Last reviewed
16 Jan 2025
Next review
16 Jan 2027
Identifier
10.71829/cei.mono.3
Certainty
High
Cycle
2024 Q1

§1Evidence extract: Obstructive sleep apnoea with obesity

§1.1Question and anchor outcome

Population
Recurrent upper-airway obstruction during sleep producing apnoeas and hypopnoeas, graded by the apnoea–hypopnoea index on polysomnography.
Intervention
Tirzepatide, subcutaneous once weekly
Comparator
As used in each contributing trial; reported per trial rather than pooled across comparator types
Anchor outcome
Change in apnoea–hypopnoea index (events/hour)

Additional outcomes the Institute extracts for this indication: Proportion achieving disease remission or mild disease; Change in Epworth Sleepiness Scale; Change in systolic blood pressure.

§1.2Contributing trials

Table 1. Trials contributing to the assessment of Tirzepatide in obstructive sleep apnoea with obesity.

TrialPhaseDesignRandomisedDurationYear
SURMOUNT-OSA-13Randomised, double-blind, placebo-controlled52 weeks2024
SURMOUNT-OSA-23Randomised, double-blind, placebo-controlled52 weeks2024

§1.3Certainty assessment

Certainty assessment by domainDowngrading decision recorded for each certainty domain.Certainty domainNo concernSeriousVery seriousEffect on ratingRisk of biasno downgradeInconsistencyno downgradeIndirectnessno downgradeImprecisionno downgradePublication biasno downgradeTotal downgrading: 0 levelsHigh certainty
Figure 2. Domain-by-domain certainty assessment for Tirzepatide in obstructive sleep apnoea with obesity. The starting rating for a body of randomised evidence is high; each serious concern reduces it by one level and each very serious concern by two.

Table 2. Reasoning recorded against each certainty domain.

DomainRatingReasoning
Risk of biasNo concernNo serious concern identified in this domain.
InconsistencyNo concernNo serious concern identified in this domain.
IndirectnessNo concernNo serious concern identified in this domain.
ImprecisionNo concernNo serious concern identified in this domain.
Publication biasNo concernNo serious concern identified in this domain.
Overall rating: High certainty. The Institute is confident that the true effect lies close to the estimate. Further research is very unlikely to change confidence in the estimate.

§1.4What this extract does not establish

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.

  1. Jastreboff AM, Aronne LJ, Ahmad NN, Wharton S, Connery L, Alves B, Kiyosue A, Zhang S, Liu B, Bunck MC, Stefanski A. Tirzepatide once weekly for the treatment of obesity. New England Journal of Medicine 2022;387(3):205–216. doi:10.1056/NEJMoa2206038 · PMID 35658024
  2. Garvey WT, Frias JP, Jastreboff AM, le Roux CW, Sattar N, Aizenberg D, Mao H, Zhang S, Ahmad NN, Bunck MC, Benabbad I, Zhang XM. Tirzepatide once weekly for the treatment of obesity in people with type 2 diabetes (SURMOUNT-2): a double-blind, randomised, multicentre, placebo-controlled, phase 3 trial. The Lancet 2023;402(10402):613–626. doi:10.1016/S0140-6736(23)01200-X · PMID 37385275
  3. Wadden TA, Chao AM, Machineni S, Kushner R, Ard J, Srivastava G, Halpern B, Zhang S, Chen J, Bunck MC, Ahmad NN, Forrester T. Tirzepatide after intensive lifestyle intervention in adults with overweight or obesity: the SURMOUNT-3 phase 3 trial. Nature Medicine 2023;29(11):2909–2918. doi:10.1038/s41591-023-02597-w · PMID 37840095

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