Dr. Ahmed
Rybelsus vs Wegovy? Both drugs belong to the same class of medicines but which drug is the most effective for the treatment of obesity?
Until now, Semaglutide is only marketed by Novo Nordisk. It is marketed in three different formulations:
Rybelsus and Ozempic are FDA-approved for the treatment of Diabetes, while Wegovy is FDA-approved only for the treatment of obesity.
Different Semaglutide Formulations:
Rybelsus is available as oral tablets formulation in doses of:
- 3 mg,
- 7 mg, and
- 14 mg.
Ozempic and Wegovy are injectable formulations of Semaglutide that are administered via subcutaneous injections once weekly.
Ozempic is given in doses of:
- 0.25 mg per week for four weeks, followed by 0.5 mg per week for four weeks.
- Patients who are well-controlled on 0.5 mg are advised to continue 0.5 mg, while those patients who do not achieve their glucose targets are advised to increase the dose to the maximum of 1 mg subcutaneously weekly.
Wegovy is advised for obese patients in the following doses:
- 0.25 mg per week for four weeks
- 0.5 mg per week for four weeks
- 1 mg per week for four weeks
- 1.7 mg per week for four weeks, and then the maintenance dose of
- 2.4 mg per week.
The maintenance and the maximum dose of Wegovy is 2.4 mg per week.
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Rybelsus vs Wegovy for Weight Loss?
Although Rybelsus is not a weight-loss drug. It has only been approved by the FDA for the treatment of Diabetes, it has been observed to cause significant weight loss.
On the other hand, Wegovy, an injectable formulation of Semaglutide is primarily approved as a weight-loss drug.
It is thus logical to presume that Wegovy, a weight-loss drug, must be superior to Rybelsus, a non-weight-loss drug.
However, we should look into the evidence too. The two formulations have not been compared for weight loss in a head-to-head clinical trial, we are comparing the weight loss effects of these drugs in clinical trials compared to placebo medicine.
Weight loss with Rybelsus:
Rybelsus is the same drug as Wegovy. The formulations and the doses differ.
Rybelsus is associated with significant weight loss compared to placebo. This is shown in the table below:
| Baseline Weight | Weight after 26 weeks | Mean Weight Loss | |
| Placebo | 88.6 | 87.2 | -1.4 kgs |
| Rybelsus 7 mg | 89 | 86.7 | -2.3 kgs |
| Rybelsus 14 mg | 88.1 | 84.4 | -3.7 kgs |
Rybelsus has superior efficacy when compared with metformin, Januvia, and Jardiance. Compared to Liraglutide, it has comparable weight loss effects.
Two trials, OASIS and Pioneer Plus have demonstrated the efficacy and safety of high-dose oral Rybelsus for weight loss. The estimated weight loss with 50 mg once daily oral Rybelsus is about 16% which is equivalent to that of Wegovy.
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Weight loss with Wegovy:
Wegovy got FDA approval for weight loss after the STEPs Trials. Results of the STEPs trials have been discussed in detail here:
The weight loss effects in these clinical trials ranged from 9.6% to 16%. Furthermore, it was also effective in the maintenance treatment of obesity compared to a placebo.
Wegovy has been tested on diabetics and non-diabetics. It has been approved by the FDA for the treatment of obesity in individuals with or without diabetes.
In various clinical trials, it has shown superior results in terms of weight loss compared to Saxenda, Xenical, Contrave, and other weight loss drugs.
Compared to Ozempic and Rybelsus, Wegovy is associated with greater weight loss as shown below:
Rybelsus is associated with a mean weight loss of about 8 pounds or 4.4% of the body weight. Wegovy, on the other hand, is associated with about 16% weight loss.
The high-dose Rybelsus (50 mg once daily) is as effective as Wegovy once weekly.
Until now, Wegovy was considered the most effective weight loss drug. However, Tirzepatide is awaiting FDA approval for weight loss.
Tirzepatide is already marketed under the brand name, Mounjaro for Diabetes. It is associated with 21% weight loss and might be superior to Ozempic and Wegovy.
Other drugs which are considered more effective than Rybelsus, Wegovy, and Mounjaro include:
- Retatrutide and
- CagriSema
These drugs are in clinical trials and may change obesity management altogether.
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In conclusion:
Although Rybelsus is an easy-to-take oral medicine and is associated with significant weight loss, it is still much less effective compared to Wegovy in terms of its weight loss effects.
Its higher dose formulation may soon get approval which has equivalent efficacy as Wegovy and Ozempic.
