Dr. Ahmed Type 2 diabetes is a leading concern these days, and its proper management requires effective management of blood glucose levels. Certain medications that maintain sugar levels in the normal range are essential for diabetics.
Two leading medicines are Rybelsus (Semaglutide) and Victoza (Liraglutide), which belong to the class GLP-1 (Glucagon-like peptide 1) agonists.
Rybelsus vs Victoza is a short comparison of these two drugs in terms of their mechanism of action, dosage, efficacy and possible side effects.
What is Rybelsus
Rybelsus (Semaglutide) is an FDA-approved oral medication used to treat type 2 diabetes in adults to maintain normal blood glucose levels.
This drug belongs to the class of GLP-1 receptor agonists (Glucagon-like peptide-1 receptor agonists).
It is being tested in higher doses of up to 50 mg per day as an oral treatment for weight loss after the company saw a dramatic response with Ozempic and Wegovy.
What is Victoza
Victoza (Liraglutide) is an injectable medication for the treatment of type 2 diabetes. This drug also acts as a GLP-1 receptor agonist that helps to maintain blood sugar levels along with diet and regular physical activity.
In higher doses, it is indicated for weight loss, under the brand name, Saxenda.
Mechanism of Action of Rybelsus Vs. Victoza:
Both Rybelsus and Victoza are GLP-1 analogs, Semaglutide and Liraglutide respectively.
The primary mechanism of action of both these drugs is the same. However, Rybelsus (Semaglutide) is administered orally while Victoza (Liraglutide) is an injectable medicine.
In addition, Rybelsus has a relatively longer half life compared to Victoza. In addition, Semaglutide is very similar, almost 97%, to the normal body GLP-1.
The molecule of Semaglutide is very small and hence it can cross the blood brain barrier offsetting the craving centre in the brain resulting in early satiety.
Rybelsus MOA:
Rybelsus is designed to mimic the action of GLP-1, a natural incretin hormone that helps regulate blood sugar levels after meals.
When blood glucose is high, the pancreas stimulates the release of more insulin, which controls blood sugar levels and improves insulin secretion.
Rybelsus reduces the amount of glucagon secreted by the pancreas, which decreases glucose production and is released by the liver, helping to regulate blood sugar levels.
Rybelsus slows stomach emptying, helping you feel fuller longer and reducing hunger, which can lead to weight loss.
The modified structure of Rybelsus protects it from degradation by DPP-4, resulting in a longer-lasting effect and the ability to be taken once daily.
Victoza MOA:
Like Rybelsus, Victoza mimics GLP-1 to boast post-meal insulin secretion. Victoza helps the body release insulin when blood sugar levels are high, improving blood sugar control.
It also helps lower blood sugar by reducing the amount of glucose the liver releases. Victoza helps you feel fuller for longer by slowing the emptiness of the stomach, making it helpful for achieving and maintaining a healthy weight.
The addition of fatty acid to Victoza extends its duration of action, making it effective with just one daily dose.
Dosage of Rybelsus Vs Victoza:
Rybelsus:
Starting dosage: To start, take 3 mg once a day for the first 30 days.
Maintenance Dosage: After that, you may increase your dose to 7 mg once a day for ongoing treatment.
Further, Increase: If additional blood sugar control is needed, increase your dose to 14 mg once a day, but only after at least 30 days on the 7 mg dose.
Administration Instructions:
Swallow the tablet whole for at least 30 minutes before eating or drinking anything, including other medications. You can take it with up to 4 ounces of plain water, but avoid splitting, crushing, or chewing it.
Victoza:
Starting Dosage: Take 0.6 mg of Victoza once a day for the week.
Maintenance Dosage: After that, you may increase your dose to 1.2 mg once a day.
Further Increase: If you need even better blood sugar control, increase your dose to 1.8 mg once a day, but only after at least a week on the 1.2 mg dose.
Efficacy of Rybelsus Vs Victoza:
Both Rybelsus (Semaglutide) and Victoza (Liraglutide) are GLP-1 receptor agonists, but they have almost similar action and efficacy modes. However, some studies have been done to check the efficacy and safety of oral Semaglutide vs subcutaneous liraglutide.
According to PIONEER trials, in a 26-week period, participants with type 2 diabetes received oral Semaglutide and subcutaneous Liraglutide.
The study concluded that oral Semaglutide was equally effective as subcutaneous liraglutide and superior to placebo. Moreover, oral Semaglutide was superior to both in reducing weight. [Ref]
Another study that checked the lifetime cost-effectiveness of oral Semaglutide vs dulaglutide and liraglutide results revealed that oral Semaglutide cost $144,065 and was favored 52.10% among patients, making it a cost-effective treatment option. [Ref]
Another systematic trial, with a total of 9.890 patients, indicated that oral Semaglutide significantly reduces HbA1c and body weight.
Moreover, it was superior to all other comparators, including liraglutide, empagliflozin, and sitagliptin. More importantly, oral Semaglutide was associated with a reduction in overall mortality. However, treatment with oral Semaglutide is linked with GI side effects. [Ref]
Side effects
| Rybelsus | Victoza |
| Common – General Sickness – Vomiting and Nausea – Acidity – Abdominal cramps – Reduced appetite Serious Side Effects – Vision Changes – Thyroid tumors – Hypoglycemia – Inflammation in the pancreas | Common Side Effects: – Diarrhea – Tremors – Anxiety – Headache – Nausea – Low blood sugar Serious Side Effects: – Kidney problems – Inflammation – Hypoglycemia |
Drug Interactions
Rybelsus
Rybelsus can interact with certain medications, such as
- Using Rybelsus with medicines like Sulfonylureas (e.g., glimepiride, glipizide) and insulin can increase the risk of hypoglycemia.
- Ace inhibitors might work simultaneously with Rybelsus and improve its sugar-lowering action.
- Corticosteroids can lower the effects of Rybelsus.
Gastrointestinal Effects:
Rybelsus slows the emptying of the stomach, which can influence the absorption of other oral medications. Take Rybelsus 30 minutes before taking any other oral medications, to reduce the risk of these interactions.
Victoza (Liraglutide)
Victoza can interact with certain medications, including:
- Insulin and Sulfonylureas, when used with Victoza, can result in hypoglycemia.
- Just like Rybelsus, Victoza’s efficacy is also reduced when administered with corticosteroids.
- Beta-blockers may hide the symptoms of low blood sugar (hypoglycemia), making it more difficult to detect and treat.
Herbs and supplements: Some herbs and supplements, such as garlic, may enhance the blood sugar-lowering effect of Victoza, increasing the risk of hypoglycemia.
Conclusion
Rybelsus (Semaglutide) and Victoza (liraglutide) are both effective anti-diabetic medications, but they have distinct advantages.
Rybelsus offers the convenience of taking pills by mouth, while Victoza has a proven track record of protecting against cardiovascular disease (CVD). However, Rybelsus appears to be a more favorable choice based on head-to-head comparisons.
But still, the most effective treatment plan varies from person to person, and it is essential to work closely with your doctor to determine the best medication for your individual needs.
