A Pharmacological and Clinical Overview of Oral Semaglutide for the Treatment of Type 2 Diabetes

May 8, 2021Drugs

Overview of Oral Semaglutide Medicine for Treating Type 2 Diabetes

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Abstract

Oral semaglutide (Rybelsus) achieved effective glycemic control in patients with type 2 diabetes.

Treatment with oral semaglutide led to reductions in body weight and decreases in systolic blood pressure.
The medication was well tolerated, with a safety profile consistent with other GLP-1 receptor agonists.
The risk of hypoglycemia was low, and the most common adverse events were gastrointestinal, including nausea and diarrhea.
Cardiovascular safety was noninferior to placebo, suggesting a similar profile to subcutaneous semaglutide.

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Oral semaglutide (Rybelsus) is a glucagon-like peptide-1 (GLP-1) receptor agonist (GLP-1RA) with 94% homology to human GLP-1. It is the first GLP-1RA developed for oral administration, and it comprises a co-formulation of the peptide semaglutide with the absorption enhancer sodium N-(8-[2-hydroxybenzoyl] amino) caprylate, which overcomes the challenges of peptide absorption in the acidic conditions of the stomach. Oral semaglutide is indicated for use as an add-on combination therapy (with other glucose-lowering agents, including insulin) or as a monotherapy (in patients who are intolerant to metformin) for type 2 diabetes when diet and exercise do not provide adequate glycemic control. In an extensive phase III clinical program including patients from across the disease spectrum, treatment with oral semaglutide resulted in effective glycemic control, reductions in body weight, and decreases in systolic blood pressure when used as monotherapy or in combination with other glucose-lowering therapies. Studies showed that oral semaglutide was well tolerated, with a safety profile consistent with the GLP-1RA drug class. The risk of hypoglycemia was low, and the most common adverse events were gastrointestinal, with nausea and diarrhea generally being the most frequently reported manifestations. Cardiovascular (CV) safety was shown to be noninferior to placebo and observations suggest that the CV profile of oral semaglutide is likely to be similar to that of subcutaneous semaglutide. The evolution of the GLP-1RA class to include an oral agent could facilitate the use of these agents earlier in the diabetes treatment cascade owing to wider acceptance from patients and healthcare professionals. ®

Key numbers

−1.9%

HbA Reduction

Mean change from baseline with oral semaglutide 14 mg vs. placebo at week 26.

−2.5 kg

Weight Loss

Mean change from baseline with oral semaglutide 14 mg vs. sitagliptin at week 26.

0.79

Cardiovascular Safety Hazard Ratio

Hazard ratio for major adverse cardiovascular events in the PIONEER 6 trial.

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A Pharmacological and Clinical Overview of Oral Semaglutide for the Treatment of Type 2 Diabetes

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