What about long term risks

The short version: the retrieved evidence does not include any long-term safety data for tirzepatide beyond 88 weeks, so the question of risks from years of use cannot be answered from these records.

The longest trial in the evidence is the SURMOUNT-4 extension, which followed people for 88 weeks and found that stopping tirzepatide led to about 14% weight regain, while continuing maintained roughly 19.4% total weight loss [1]. That is a useful finding about weight maintenance, but it is not a long-term safety study. The SURMOUNT-OSA trial ran for 52 weeks and reported that 40–50% of tirzepatide users no longer needed CPAP for sleep apnea, but the same record explicitly notes that longer-term safety data was not provided [2].

The 2023 profile review lists common gastrointestinal side effects and notes rare cases of pancreatitis, cholelithiasis, and tachycardia observed in a subset of patients [5]. It also flags that ongoing evaluation of long-term safety is needed for pancreato-biliary, retinopathy, and thyroid concerns [4]. These are warnings about what has not been studied, not findings from completed work.

The evidence base here is built on trials that measure efficacy in months, not years. The drug was approved in 2022, so the window for long-term observation is narrow by design. The 2025 network meta-analysis comparing tirzepatide to retatrutide found that both drugs had higher adverse event rates than placebo, with tirzepatide's relative risk at 2.78 [3], but that comparison covers only the trial period.

My call: the evidence does not support any conclusion about long-term risks from years of tirzepatide use, because no such study appears in these records. Confidence: not clear — the absence is real, not a gap in the search.