Soliqua Vs Ozempic: Comparing Efficacies and Side Effects

Soliqua Vs Ozempic compares the two injectable diabetes medicines. Soliqua is a brand marketed by Sanofi. It is a fixed-dose combination of Insulin Glargine and Lixisenatide.

Ozempic is a GLP-1 analog and the second most potent diabetes medicine after Mounjaro (Tirzepatide) according to the ADA (American Diabetes Association).

Although Lixisenatide is a less potent GLP-1, especially when compared to Semaglutide (Ozempic), when combined with Insulin Glargine as in Soliqua, it becomes very effective in lowering the A1C.

Ozempic and Soliqua are both injectable medicines. However, Ozempic is administered once a week while Soliqua is administered daily.

Soliqua is a fixed-dose combination of Insulin Glargine 100 units/ml and Lixisenatide 33 mcg. Unlike Adlyxin (Lixisenatide) which is administered in a dose of 10 mcg initially for 14 days followed by 20 mcg once daily, the dose of Lixisenatide in Soliqua can be titrated by as low as 0.33 mcg.

Ozempic on the other hand, is administered in a dose of 0.25 mg weekly for four weeks, followed by 0.5 mg weekly for four weeks, and then 1 mg weekly.

Soliqua Vs Ozempic: Which is more effective?

The efficacy of Soliqua has been investigated in a multicentered trial comprising more than 700 patients.

The mean HbA1C reduction compared to Insulin Glargine was very significant as mentioned in the table below:

Soliqua resulted in a greater A1C reduction Vs Glargine. The mean difference in the A1C between Soliqua and Insulin Glargine was -0.5% (in favor of Soliqua).

The efficacy of Ozempic has also been studied compared to Insulin Glargine. Here is a table of comparison:

Summarizing the above two tables, Soliqua and Ozempic are comparable but superior to Insulin Glargine in lowering A1C.

Soliqua lowered A1C by 0.5% more than Insulin Glargine while Ozempic lowered the A1C by 0.4% and 0.6% (more than Glargine) when administered in a dose of 0.5 mg and 1 mg weekly.

In addition, Ozempic (but not Soliqua) has also been proven to be more effective than the following diabetes medications:

• Ozempic 1mg Vs Liarglutide 1.2 mg: 

  • Ozempic resulted in a greater A1C reduction by -0.69% compared to Liraglutide [Ref].

• Ozempic Vs Januvia:

  • Ozempic 0.5 mg and 1 mg resulted in 0.6% and 0.8% more HbA1C reduction compared to Januvia 100 mg respectively.

• Ozempic Vs Exenatide ER 2 mg:

  • Ozempic 1 mg resulted in an A1C reduction of 0.5% more than Exenatide ER 2 mg.

• Ozempic Vs Trulicity:

  • Ozempic 0.5 mg was superior to Trulicity 0.75 mg. Ozempic 1 mg was superior to 1.5 mg. The average A1C reduction was 0.4% more than Trulicity.

Ozempic Vs Soliqua for weight loss:

Ozempic is associated with up to 10 – 16% body weight loss in clinical trials and as reported by real-life users.

Soliqua on the other hand is associated with slight weight gain or weight loss. However, it is considered weight-neutral

Soliqua Vs Ozempic: Safety Comparisons:

Soliqua and Ozempic differ in their formulations as Soliqua is a fixed-dose combination of Insulin Glargine and a GLP-1 agonist, Lixisenatide.

Ozempic is a small GLP-1 analog that is very identical to the endogenous GLP-1 produced by the human body.

Apart from the GI side effects, Soliqua use is associated with more side effects as it is a combination of two drugs.

Lixisenatide is a short-acting GLP-1 and is hence associated with fewer GI side effects. here is a table comparing the side effects of Soliqua Vs Ozempic:

The table above compares the important side effects of Ozempic vs Soliqua. Ozempic is less likely to be associated with hypoglycemia and injection-site reactions while Soliqua is safer in patients with GI problems and diabetic retinopathy.

Which Diabetes Medicine Will Best Suit You: Soliqua or Ozempic?

Diabetes and Cardiovascular Disease:

Apart from other Pros and Cons of Ozempic or Soliqua, if you have ASCVD (atherosclerotic cardiovascular disease), angina, myocardial infarction, heart failure, stroke, or kidney disease, you should not hesitate to choose Ozempic.

Lixisenatide has not been proven to have a beneficial effect in reducing cardiovascular mortality or renal outcomes.

Diabetes and Obesity:

If you are overweight or obese and wish to lose weight, Ozempic is the best choice for you. It is associated with significant weight loss. In fact, its higher dose formulation, Wegovy, has also been approved for the treatment of obesity and overweight individuals.

Although Ozempic is not a weight loss drug, it is misused by people who do not have diabetes but pure obesity.

On the other hand, Soliqua is considered weight neutral or may cause slight weight gain because it has Glargine insulin as one of the components which are associated with weight gain.

Diabetes and increased risk of hypoglycemia:

There is zero or minimal risk of hypoglycemia with Ozempic. The risk of hypoglycemia is only there if you are using Ozempic along with other diabetes medications like Insulin or sulfonylureas.

However, because Soliqua has Insulin Glargine, it is associated with an increased risk of hypoglycemia. In clinical trials, the risk of severe documented and symptomatic hypoglycemia was reported as 1% to 40%.

For people who are at an increased risk of hypoglycemia, Ozempic is the best compared to Soliqua.

Diabetes and severe GI problems:

If you have severe GI upset such as constipation, diarrhea, vomiting, nausea, or abdominal fullness and bloating, Ozempic may make it worse. Ozempic is an ultra-long-acting GLP-1 and it is associated with fullness, constipation, and bloating as it delays gastric emptying.

Compared to Ozempic, Soliqua is a safer option here because Lixisenatide is a short-acting GLP-1 and is not frequently associated with GI side effects. In addition, one can titrate the dose very slowly by up to 0.33 mcg (vs 10 mcg in Adlyxin) which essentially eliminates the gastrointestinal side effects that might happen with Lixisenatide.

Diabetes and Retinopathy:

Ozempic is more strongly associated with diabetic retinopathy compared to Soliqua. The manufacturer of Ozempic, NOVO, recommends avoiding Ozempic treatment in patients who have advanced retinopathy or who develops new-onset retinopathy after treatment initiation.

The author has attributed retinopathy with the rapid improvement in glucose control, however, it is not very clear whether Ozempic is causing it or the rapid improvement in A1C and blood glucose is causing it.

In a Nutshell:

Ozempic has numerous advantages over Soliqua. It is administered once weekly and hence is very easy, especially for busy people.

Ozempic provides added benefits like weight loss, significant A1C reduction, and cardiovascular and renal benefits, and it is also being studied for its anti-inflammatory properties as well as a treatment for alcohol dependence.

Soliqua is a good combination of Insulin Glargine and Lixisenatide that provides better A1C reduction as well as it has a favorable GI side effects profile compared to Ozempic.

However, your doctor is the best judge to provide you with the best treatment regimen.