The trial involved 667 adults with obesity or overweight with at least one comorbidity. It found that the oral form of 50 mg of semaglutide resulted in 15.1% weight loss compared to 2.4% in the placebo group.
Martin Holst Lange, executive vice president of Development at Novo Nordisk, said he was pleased with the results and “the choice between a daily tablet or weekly injection for obesity has the potential to offer patients and health care providers the opportunity to choose what best suits individual treatment preferences,” in a company statement.
Dr. Louis J. Aronne, Director of the Comprehensive Weight Control Center at Weill Cornell Medicine finds the oral option compelling and creates a greater outreach.
“Many people prefer oral dosing. Once a weekly injections, however, are very simple to administer and in some ways more convenient. Oral dosing increases the range of people who can be treated with these medications,” he tells Healthline.
Obesity and being overweight increase one’s risk of heart disease, stroke, and diabetes, and can raise the risk of developing some cancers.
Semaglutide is a medication that was developed to treat type 2 diabetes by regulating insulin by mimicking a hormone in the body called GLP-1.
GLP-1 also can tell the brain that the stomach is full, even if it is not, resulting in decreased appetite, less desire to eat, and eventual weight loss.
Ozempic is currently approved for the treatment of type 2 diabetes, but Wegovy – which uses the same drug semaglutide, has been approved for weight loss.
In the current form, these medications are currently administered through injection into the waist, thigh, or even the upper arm once a week. At times this can not only be uncomfortable for patients but creates a greater hesitancy in taking the medications as well.
An oral form of semaglutide is already available under a different brand name, Rysbelsus. However, at the dose it is prescribed, it has not shown efficacy regarding weight loss. This medication is prescribed maximally at 14 mg and at that dose, it does not assist in weight loss.
The recent trial of the oral medication from Novo Nordisk did show weight loss results at 50 mg.
“It may be likely that higher doses taken orally as opposed to subcutaneous injection may result in greater GI upset for some patients but that remains to be seen once the medication makes its way to the market,” said Dr. Sahar Takkouche, lead expert in Bariatric and Obesity Medicine and Assistant Professor in the Division of Diabetes, Endocrinology, and Metabolism at the Vanderbilt University Medical Center in Tennessee.
“Some patients may be more tolerant than others when it comes to side effects as with any medications there is variation.”
Despite the new popularity of these medications, they come with side effects, both in the injection and the oral forms. The trial showed that the most common side effect associated with these medications is GI upset. However, gastrointestinal issues are also associated with injection forms including nausea, constipation, diarrhea, vomiting, burping, and generalized abdominal pain.
With semaglutide causing GI upset, Aronne advises that these “have to be taken on an empty stomach at least half an hour away from food and other medications and you can’t take it with all of your other medications.”
In addition to the side effects, these medications can also be costly. Some insurance companies cover these medications for diabetic treatment however many do not cover them for weight loss costing people around $1,000 out of pocket per month for treatment.
“Many insurance companies fail to recognize obesity as a medical condition and view the treatment of this disease as purely cosmetic,” says Takkouche.
She continues, “This paradigm is invalid and places our patients and the US population at risk for further decline, while raising the cost of health care for everyone.”
Other companies are quickly racing to also create oral diabetic and weight loss medications.
Pfizer is currently developing danuglipron, another oral medication for diabetes and weight loss. The company recently published a study in the journal
Similarly, to semaglutide, this medication mimics GLP-1 not only to help regulate insulin but to also tell the brain that the stomach is full and helping to regulate weight loss.
Although these medications are compelling, not everyone is the perfect fit for them.
“The best candidates for this medication are patients with a BMI over 30 or a BMI over 27 plus an obesity related comorbidity such as type 2 diabetes, hypertension, hyperlipidemia, obstructive sleep apnea, or fatty liver,” explained Takkouche.
Medication therapy is a compelling way for many to lose weight if diet and exercise are not suitable options for an individual and with several companies working to approve oral medications – the number of people that can benefit from these medications may be increasing.
Dr. Rajiv Bahl, MBA, MS, is an emergency medicine physician, board member of the Florida College of Emergency Physicians, and health writer. You can find him at RajivBahlMD.