Adverse effects with tirzepatide: a protocol for a systematic review with meta-analysis and Trial Sequential Analysis

Christina Dam Bjerregaard Sillassen, Johanne Juul Petersen, Caroline Barkholt Kamp, Johannes Grand, Helena Dominguez, Anne Frølich, Peter Haulund Gæde, Christian Gluud, Ole Mathiesen, Janus C Jakobsen

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Abstract

INTRODUCTION: Cardiovascular diseases remain the leading cause of mortality worldwide. Tirzepatide is approved for the treatment of type 2 diabetes mellitus and overweight and is increasingly used. The adverse effects with tirzepatide may not be disease-specific and have not been assessed previously.

METHODS AND ANALYSIS: We will conduct a systematic review and search major medical databases (Cochrane Central Register of Controlled Trials, Medical Literature Analysis and Retrieval System Online (MEDLINE), Excerpta Medica database (EMBASE), Latin American and Caribbean Health Sciences Literature (LILACS), Science Citation Index Expanded (SCI-EXPANDED), Conference Proceedings Citation Index-Science (CPCI-S)) and clinical trial registries from their inception and onwards to identify relevant randomised clinical trials. We expect to conduct the literature search in January 2025. Two review authors will independently extract data and perform risk of bias assessments. We will include randomised clinical trials comparing tirzepatide versus placebo or no intervention in all patient groups with an increased risk of cardiovascular events. Primary outcomes will be all-cause mortality and serious adverse events. Secondary outcomes will be myocardial infarction, stroke, all-cause hospitalisation and non-serious adverse events. Data will be synthesised by meta-analyses and Trial Sequential Analysis, risk of bias will be assessed with the Cochrane Risk of Bias tool-version 2. We will systematically assess if the thresholds for statistical and clinical significance are crossed, and the certainty of the evidence will be assessed by Grading of Recommendations, Assessment, Development and Evaluations.

ETHICS AND DISSEMINATION: This protocol does not present any results. Findings of this systematic review will be published in international peer-reviewed scientific journals.

PROSPERO REGISTRATION NUMBER: CRD42024599035.

Original languageEnglish
Article numbere094947
JournalBMJ Open
Volume15
Issue number4
Number of pages7
ISSN2044-6055
DOIs
Publication statusPublished - 2025

Bibliographical note

© Author(s) (or their employer(s)) 2025. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ Group.

Keywords

  • Humans
  • Systematic Reviews as Topic
  • Meta-Analysis as Topic
  • Research Design
  • Diabetes Mellitus, Type 2/drug therapy
  • Cardiovascular Diseases
  • Hypoglycemic Agents/adverse effects
  • Randomized Controlled Trials as Topic
  • Tirzepatide

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