Dr. Ahmed
Rybelsus Vs Januvia and Janumet is a comparison of the efficacies of the two drugs. How effective are Rybelsus and Januvia and Janumet in controlling diabetes and weight loss, is discussed along with other basic similarities and differences.
What is Rybelsus?
Rybelsus is the newer generation GLP-1 analog. It is the orally available form of Semaglutide that is used to treat patients with Diabetes Mellitus Type 2.
It is associated with significant weight loss, although, it is not approved for treating obesity in non-diabetic individuals. However, a higher dose of 50 mg per day is being investigated for the treatment of obesity.
The other two formulations of this newer generation of Semaglutide are:
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Ozempic:
Ozempic is the injectable form of Semaglutide that is administered once a week. It has been approved by the FDA for the treatment of patients with T2DM.
It is available as a 2 mg/1.5 mL (1.34 mg/mL) injection that can be either used as:
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- to inject 0.25 mg or 0.5 mg of the drug
- 1 mg of the drug per injection, up to a maximum weekly single dose of 2 mg.
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Wegovy:
Wegovy is a once-a-week injection of Semaglutide that has recently been approved by the FDA for the treatment of individuals who are either obese or overweight with or without T2DM.
It is to be administered as a subcutaneous injection once a week in a dose of 2.4 mg. In clinical trials, Wegovy was associated with a weight loss of about 16% from the baseline at the end of the trial.
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What are Januvia and Janumet?
Januvia is the brand name of Sitagliptin. It is also available in combination with metformin as Janumet (Sitagliptin + metformin).
Sitagliptin is one of the commonly used DPP-4 inhibitors. It is indicated for the treatment of type 2 diabetes mellitus.
It can be administered once or twice daily. Januvia is a weight-neutral, euglycemic drug.
Comparing Rybelsus vs Januvia and Janumet:
Mechanism of action of Rybelsus and Januvia:
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Rybelsus MOA:
Rybelsus is oral Semaglutide. It is the newer generation of Semaglutide that is 94% structurally identical to the endogenous Semaglutide.
It primarily acts as an incretin mimetic and causes the release of insulin in a glucose-dependent manner. It also suppresses the release of glucagon and inhibits gastric motility.
It has direct and indirect effects on appetite suppression and is therefore associated with marked weight loss.
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Januvia MOA:
Januvia is the brand name of Sitagliptin. It is a DPP IV inhibitor that primarily acts by increasing the levels of endogenous GLP-1 levels.
DPP IV or dipeptidyl peptidase-IV enzyme is responsible for degrading the endogenous GLP-1. Thus, in normal individuals, the usual half-life of the endogenous is very brief.
Januvia inhibits the DPP-IV enzyme that is responsible for degrading the endogenous GLP-1, thereby, increasing the half-life of the endogenous GLP-1 resulting in a greater and sustained release of insulin, suppressing glucagon, and inhibiting gastric motility.
Janumet is a combination of Sitagliptin and metformin. The combination pill incorporates the mechanism of metformin as well and thus, Jaunmet also increases insulin sensitivity in the target tissues. It also inhibits glycogenolysis and gluconeogenesis.
Rybelsus mimics endogenous incretins while Januvia blocks the enzyme that degrades the incretins increasing the half-life of incretins.
Other Similarities and Differences between Rybelsus and Januvia are highlighted in the table below:
Pharmacology of Rybelsus Vs Januvia |
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Rybelsus |
Januvia |
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| Class | GLP-1 analog | DPP-IV inhibitor |
| Dosage strength | 3 mg, 7 mg, and 14 mg oral tablets | 50 mg and 100 mg oral tablets.
It is also, available in combination with metformin as Janumet |
| Bioavailability | 89% | 87% |
| Half-life elimination | One week | 8 – 14 hours |
| Steady State Concentration | 4 – 5 weeks | 4 – 5 days |
| Peak plasma concentration | One hour after the administration | 1 – 4 hours |
Can You Take Januvia and Rybelsus Together?
No. Rybelsus is an incretin while Januvia increases the half-life of endogenous incretins. Because their mechanism of action is very similar and they both stimulate the pancreas to release more insulin and inhibit gastric movements, the risk of adverse reactions multiplies.
The most serious or dreaded complication that can occur if Januvia and Rybelsus are given together is pancreatitis.
In addition, the risk of other gastrointestinal side effects also doubles.
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Rybelsus vs Januvia Weight Loss Comparison:
Rybelsus and Januvia are both drugs used to treat diabetes. They have not been approved for the treatment of obesity.
However, the injectable formulation of Rybelsus, Wegovy has been approved by the FDA for the treatment of obesity in individuals with or without diabetes.
The Pioneer-IV trial evaluated and compared the weight loss effects of Rybelsus and Januvia.
In patients who had a baseline weight of 200 pounds (90.7 kgs), Rybelsus in a dose of 7 mg and 14 mg significantly reduced weight compared to Januvia 100 mg [Ref].
A mean weight loss of 4.8 pounds (2.2 kgs) and 6.8 pounds (3.1 kgs) was observed with Rybelsus administered in a dose of 7 mg and 14 mg daily compared to 1.3 pounds (0.6 kgs) only with Januvia (Sitagliptin) 100 mg daily.
Rybelsus 7 mg |
Rybelsus 14 mg |
Januvia 100 mg |
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| Weight Loss | 4.8 lbs (2.2 kgs) | 6.8 lbs (3.1 kgs) | 1.3 lbs (0.6 kgs) |
| Times weight loss Vs Januvia 100 mg | 3.69 times greater weight loss | 5 times greater weight loss | – |
People who took Rybelsus in a dose of 7 mg daily had 3.69 times greater weight loss compared to Januvia 100 mg daily.
Those who took Rybelsus in a dose of 14 mg daily had a 5 times greater weight loss compared to Januvia 100 mg daily.
Janumet has a weight-neutral effect while Rybelsus resulted in significant weight loss as seen below:
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Rybelsus Vs Januvia and Janumet for Diabetes:
The Pioneer-IV Trial compared Rybelsus and Januvia in a head-to-head comparison. Patients had a mean baseline glycated hemoglobin of 8.3% [Ref]. There were three groups of patients:
- One group of patients receives Rybelsus in a dose of 7 mg daily
- One group received Rybelsus in a dose of 14 mg daily, and
- the third group received Januvia (Sitagliptin) in a dose of 100 mg orally daily.
At the end of 26 weeks study period, Rybelsus reduced the HbA1C by 1% and 1.3% when administered in doses of 7 mg and 14 mg compared to an HbA1C reduction of only 0.8% with Januvia (Sitagliptin).
Rybelsus 7 mg |
Rybelsus 14 mg |
Januvia 100 mg |
|
| A1C Reduction | 1% | 1.3% | 0.8% |
| Times Rybelsus is more effective than Januvia | 1.25 greater A1C reduction | 1.625 times greater A1C reduction | – |
In Summary:
Rybelsus is a promising new drug added to the list of anti-diabetic medications. Apart from its efficacy in better-controlling diabetes, it also has a superior weight-losing effect in diabetic patients when compared with Januvia (Sitagliptin).
Rybelsus may soon get approval as a weight loss drug since its higher dose formulation of 50 mg per day has been found to be as effective as Wegovy and Tirzepatide.
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