Dr. Ahmed
Semaglutide is available by the names of Ozempic, Rybelsus, and Wegovy. Their indications, efficacies, cost, and side effects differ.
Semaglutide is a newly approved GLP-1 analog. It has been approved for the treatment of diabetes and obesity.
It is one of the five weight-loss drugs that has been approved by the FDA for the treatment of obesity.
The other four weight-loss drugs that have been previously approved are:
- Orlistat (Xenical)
- Liraglutide (Saxenda and Victoza)
- Phentermine/ Topiramate ER (Qsymia)
- Naltrexone ER/ Bupropion ER (Contrave)
Lorcaserin (Belviq) was previously approved for weight loss but has been withdrawn from the markets because of its association with cancers.
Liraglutide and Semaglutide are the two GLP-1 analogs that have been approved for the treatment of diabesity (diabetes and obesity).
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How does Semaglutide Work?
Semaglutide is a novel GLP-1 analog that has a 94% similarity in structure to endogenous GLP-1. It reduces blood glucose in a glucose-dependent manner.
Hence, it does not cause hypoglycemia unless it is used in combination with either insulin or sulfonylureas.
It also acts on the central receptors in the hypothalamus that modulates satiety. It binds to the hunger and satiety receptors in the brain. This results in a dual action:
- Less craving for foods with the high glycemic index
- Suppression of hunger.
Semaglutide also inhibits stomach motility and causes gastric fullness. Inhibition of gastric motility causes stomach distension and induces nausea. In fact, nausea is the most common side effect of GLP-1 analogs.
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What is the difference between the 3 Semaglutide Names: Rybelsus, Ozempic, and Wegovy?
Rybelsus is a tablet formulation of Semaglutide. It is available in a dose of 3 mg, 7 mg, and 14 mg oral tablets that are taken by the patients once daily after meals.
It is primarily indicated for the treatment of diabetes. Rybelsus treatment is initiated at a dose of 3 mg.
Ozempic is an injectable formulation of Semaglutide that is administered once a week. It is administered in a dose of 0.25 mg and 0.5 mg as once a week subcutaneous injection.
The dose is given once weekly subcutaneously starting from the lowest dose of 0.25 mg which is then titrated upwards if required.
Wegovy is a high-dose injectable Semaglutide administered in a dose of 2.4 mg once weekly under the skin. It is primarily indicated for the treatment of obesity.
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How Effective is Semaglutide in Lowering Glycated Hemoglobin (A1C)?
Different formulations of the drug have been shown to have variable efficacy in the treatment of diabetes mellitus.
Furthermore, the baseline Glycated hemoglobin, intensive lifestyle intervention, and concomitant medications may also influence the decline in glycated hemoglobin.
Rybelsus Efficacy in the Treatment of Diabetes:
- Oral Rybelsus has been evaluated in a 52-week clinical trial. In a dose-escalated manner, it resulted in a decline in glycated hemoglobin of 1.2% from the baseline.
Ozempic efficacy in T2DM patients:
- Ozempic administered in a dose of 0.5 mg once weekly resulted in lowering glycated hemoglobin by 1.2%.
- When administered in a dose of 1 mg subcutaneously weekly, it resulted in a reduction of glycated hemoglobin by 1.8%.
Wegovy (High dose Injectable Semaglutide) in T2DM:
- Wegovy is a high-dose injectable Semaglutide. It causes a reduction in glycated hemoglobin by 1.8% to 2.4%.
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How much weight loss is expected with the use of Semaglutide?
Semaglutide is considered a promising weight-loss drug. Wegovy, a high dose once-weekly injectable Semaglutide, has been FDA-approved for the treatment of obesity.
It causes weight loss via multiple mechanisms including early satiety, postprandial fullness, and central mechanisms.
Rybelsus administered orally has been shown to cause a mean weight loss of about 4.4 kgs over six months to one year.
Ozempic is a low dose of once-weekly Injectable Semaglutide that causes a weight loss of about 13 pounds (6 kgs) over 6 months to one year.
Wegovy is a high-dose once weekly Injectable Semaglutide that causes a weight loss of about 16% from the baseline.
The STEPS Trials showed the superiority of Wegovy over placebo. It also suggested that weight loss is maintained over a long period of time even after treatment discontinuation.
In Conclusion;
Semaglutide causes a significant reduction in glycated hemoglobin and weight in obese patients with diabetes.
It is available in three different formulations and brand names: Ozempic, Wegovy, and Rybelsus.
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