Oral semaglutide may be a promising alternative

“Having semaglutide available as an oral or injectable allows accommodation for patient preferences,” said Vanita R. Aroda, MD, who specializes in endocrinology, diabetes, and hypertension at Brigham and Women’s Hospital in Boston. Aroda was also not involved in the new study.

”This flexibility may be especially important for adolescents where there is a major need for safe pharmacology treatments,” noted Andrew Hogan, PhD, who is an associate professor of immunology at Ireland’s Maynooth University, and also not involved in the study.

Ahmed added that oral semaglutide may also offer reassurance for some current semaglutide patients concerned about nationwide shortages of the injectable drug.

Dosage makes a difference

The typical dosing for Ozempic, said Ahmed, is weekly doses of 0.25 mg, 0.5 mg, 1 mg, and 2 mg, increased at four-week intervals based on the presence and toleration of gastrointestinal side effects. For Wegovy, it is 0.25 mg, 0.5 mg, 1 mg, 1.7 mg, and 2.4 mg per week, increased in the same manner.

The participants in the new study were given daily oral prescriptions of 3 mg before being raised to 7 mg. Most of the study cohort remained at a maximum of 7 mg daily for the study period.

For about 2% of participants, the daily dose was increased to 14 mg. The researchers reported that even the 14 mg dose was generally well tolerated.

At 14 mg per day, the weekly dose adds up to 98 mg per week, far larger than the maximum Wegovy dose of 2.4 mg per week.

Aroda explained why study participants were able to tolerate such a high dose of the drug. “Keep in mind, the bioavailability of semaglutide — the amount of semaglutide that actually is absorbed via the [gastrointestinal] tract — is quite low,” she said.

“The levels of semaglutide, in the blood achieved tend to be slightly less and more variable than what is seen with injectable semaglutide doses that are available,” she reported.

Hogan pointed out the high tolerability of oral semaglutide in another study, nothing that, “[i]n the OASIS trialsTrusted Source, it was tested at 50 mg daily and the side effects seemed to be similar to injections — mild to moderate nausea — which faded over time.”

Beyond patient preferences, injectable semaglutide is more effective than the oral version. Even so, said Hogan:

“Oral delivery of semaglutide — and potentially future formulations — will make these medications more accessible, allowing doctors to choose the best route for their patient.”