Semaglutide vs Dulaglutide (Rybelsus and Ozempic Vs Trulicity)

Semaglutide vs Dulaglutide is a comparison of the two novel GLP-1 analogs. Semaglutide is available in three formulations i.e Rybelsus, Ozempic, and Wegovy. Dulaglutide is only available as Trulicity Injection.

Rybelsus is an oral tablet formulation available as 3 mg, 7 mg, and 14 mg tablets.
Ozempic is available as 0.5 mg and 1.0 mg subcutaneous injections.
Wegovy is available as a 2.4 mg once-weekly injection.

Trulicity is available as 0.75 mg and 1.5 mg subcutaneous once-weekly injections. These drugs exert their effects by acting as incretin mimetics.

Hence, they both cause the release of insulin and suppress glucagon in a glucose-dependent mechanism.

When glucose is elevated in the plasma, they cause the release of insulin and simultaneously suppresses glucagon levels.

These drugs also inhibit the motility of the stomach and delay gastric emptying.

This can cause nausea, vomiting, abdominal fullness, and bloating, and suppresses the appetite. Thus, they may also have a weight-losing effect.

However, the FDA has approved Semaglutide only for the management of obesity. Dulaglutide is only approved for the management of diabetes.

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Similarities and differences between Semaglutide Vs Dulaglutide:

	Semaglutide	Dulaglutide
Drug Class	GLP-1 analog	GLP-1 analog
Manufacturer’s Names	Novo Nordisk	Eli Lilly
Brand names	Rybelsus Ozempic Wegovy	Trulicity
Formulations available	Oral Tablets Subcutaneous Injection	Subcutaneous Injection
Indications	FDA-approved for Diabetes and Obesity	FDA-approved for Diabetes only
Cost Comparison	Each Tablet of 3 mg, 7 mg, and 14 mg costs: USD 30.90 Ozempic Pen Injector (0.25 mg and 0.5 mg/dose) 2 mg/1.5 mg costs: USD 617.95 Ozempic (1 mg/dose) 2 mg/1.5 ml costs USD 308.97 Wegovy Price 2.4 mg/dose for weight loss: Not known yet	0.75 mg/ml: USD 227.82 1.5 mg/ml: USD 227.82

Semaglutide has three formulations. The FDA has approved two (Ozempic and Rybelsus) for the treatment of Diabetes Mellitus.

Rybelsus is administered as once-daily oral tablets while the other two formulations, Ozempic and Wegovy, like Trulicity, are administered once a week.

Wegovy is approved only for weight loss. On the other hand, Trulicity is only approved for the treatment of diabetes.

Semaglutide is more like the endogenously released GLP-1. It crosses the blood-brain barrier and has a greater effect on the hunger center of the brain compared to Dulaglutide (Trulicity).

In addition, Semaglutide is much more costly compared to Dulaglutide.

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Pharmacokinetics Comparison of Semaglutide Vs Dulaglutide:

	Semaglutide	Dulaglutide
Peak Plasma concentrations	1 – 3 days after a single dose	24 to 72 hours
Half-life elimination	One week (It stays in the body for about 5 weeks)	Five days
Excretion/ Metabolism	Excreted in Urine and feces	It is metabolized into amino acids in the body
Administration	The oral tablet is administered once daily after meals. The injections are administered once weekly as a subcutaneous injection	It is administered once weekly subcutaneously into the anterior abdomen.

The onset and duration of action of both these drugs are similar. Trulicity administration requires a little training before it can be injected by the person at home.

Ozempic and Wegovy can both be administered easily just like insulin pens where the dose is dialed and injected.

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Semaglutide Vs Dulaglutide for Diabetes and Weight Loss:

	Semaglutide	Dulaglutide
Efficacy in Diabetes	Efficacy of 0.5 mg once-weekly injection: HbA1C reduction of 1.5% Efficacy of 1 mg once-weekly Semaglutide injection: HbA1C reduction of 1.8%. Efficacy of Oral Semaglutide (dose-escalated from 3 to 7 and 14 mg daily) resulted in an: HbA1C reduction of 1.2% at 52 weeks.	Efficacy of 0.75 mg once-weekly injection: HbA1C reduction of 1.1% Efficacy of 1.5 mg once-weekly dulaglutide injection: HbA1C reduction of 1.4%
Weight loss effects	Efficacy of 0.5 mg once-weekly injection: Weight loss of 4.6 kg Efficacy of 1 mg once-weekly injection: Weight loss of 6.5 Kg Efficacy of Oral Semaglutide (dose-escalated from 3 to 7 and 14 mg daily) resulted in: a weight loss of 4.4 Kg	Efficacy of 0.75 mg once-weekly injection: Weight loss of 2.3 kg Efficacy of 1.5 mg once-weekly injection: Weight loss of 3 Kg
Side effects	All GLP-1 analogs are contraindicated in patients with a personal or a family history of medullary thyroid carcinomas and MEN II. All GLP-1 analogs are contraindicated in pregnancy The most common side effects of both Semaglutide and Dulaglutide are Nausea, post-meal bloating, vomiting, constipation or diarrhea, abdominal gases, and abdominal pain. These drugs should be avoided in patients with pancreatitis and in acute medical or surgical emergencies. GLP-1 analogs, especially Semaglutide, have been associated with an increased risk of retinopathy.

The efficacy of oral Semaglutide, Rybelsus, in lowering A1C and for weight loss is similar to Trulicity. However, the injectable formulations, Ozempic and Wegovy are much more effective compared to Trulicity injections.

In fact, Wegovy has been approved as a weight loss medicine for individuals with or without diabetes.

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In Summary:

Semaglutide (Rybelsus, Ozempic, and Wegovy) has a superior weight-losing effect compared to Trulicity (Dulaglutide).

Semaglutide is also more efficacious than Dulaglutide in terms of glycemic control.

Both Semaglutide and Dulaglutide are available as a once-weekly injection formulation, however, only Semaglutide is available as once-daily oral tablets.

Dulaglutide (Trulicity) is much cheaper than Semaglutide injections (Ozempic).

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