Ozempic: Study finds it may work in pill form

The study published in the medical journal The Lancet involved 667 adults with obesity or overweight with at least one comorbidity. It found that the 50 mg oral form of semaglutide resulted in an average change in body weight of about 15.1 percent weight loss after 68 weeks. This compared with just 2.4% in the placebo group.

They found that adverse events were common with 80 percent of people taking semaglutide ending up with symptoms. These symptoms were mostly mild to moderate gastrointestinal symptoms. Comparatively, about 46% of people in the placebo group reported symptoms.

Martin Holst Lange, executive vice president of development at Novo Nordisk, which makes Ozempic and Wegovy, said in May that he was pleased with the results and choosing between a daily tablet or a weekly injection for obesity has the potential to offer patients and healthcare providers the opportunity to choose what best suits individual treatment preferences, in a company statement.

Dr. Louis J. Aronne, director of the Comprehensive Weight Management Center at Weill Cornell Medicine, finds the oral option compelling and creates a greater outreach.

Many people prefer oral dosing. Once-a-week injections, however, are very simple to administer and in some ways more cost-effective. Oral dosing increases the range of people who can be treated with these drugs, he said in an interview in May.

According to Harvard University, approximately 69% of US adults are considered overweight or obese. THE Center for Disease Control and Prevention reports that from 2000 to 2020, the prevalence of severe obesity increased from 4.7% to 9.2%.

Obesity and being overweight increase your risk of heart disease, stroke and diabetes and can increase your risk of developing some types of cancer.

Semaglutide is a drug developed to treat type 2 diabetes by stimulating insulin secretion and lowering glucagon secretion.

It can also mimic a hormone called GLP-1 and can also tell the brain that the stomach is full, even if it isn’t, resulting in a 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 their current form, these drugs are currently being administered by injection into the waist, thigh, or even the upper arm once a week. Sometimes this can not only be uncomfortable for patients, but also create more hesitation in taking medications.

An oral form of semaglutide is already available under a different brand name, Rysbelsus. However, at the prescribed dose, it has not shown efficacy in regards to weight loss. This drug is prescribed at 14mg at most and at that dose it does not help in weight loss.

Novo Nordisk’s recent oral drug study showed weight loss results at 50mg.

It may be likely that higher doses taken by mouth than injected subcutaneously could result in more gastrointestinal distress for some patients, but that remains to be seen once the drug makes its way to market, said Dr. Sahar Takkouche, chief expert in Bariatric and Obesity Medicine and Assistant Professor in the Division of Diabetes, Endocrinology and Metabolism at Vanderbilt University Medical Center in Tennessee.

Some patients may be more tolerant than others when it comes to side effects as there is variation with any drug.

Despite the newfound popularity of these drugs, they come with side effects, both in injectable and oral forms. The study showed that the most common side effect associated with these drugs is gastrointestinal upset. However, gastrointestinal problems are also associated with injection forms including nausea, constipation, diarrhea, vomiting, belching, and generalized abdominal pain.

With semaglutide causing gastrointestinal distress, Aronne recommends taking them on an empty stomach at least half an hour away from food and other medications, and you can’t take them with all your other medications.

Besides the side effects, these drugs can also be expensive. Some insurance companies cover these drugs for diabetes treatment, but many don’t cover them for weight loss that costs people about $1,000 out of pocket a month for treatment.

Many insurance companies do not recognize obesity as a medical condition and view the treatment of this disease as purely cosmetic, says Takkouche.

He continues, this paradigm is invalid and puts our patients and the US population at risk of further decline while increasing the cost of health care for all.

Other companies are quickly racing to create oral drugs for diabetes and weight loss as well.

Pfizer is currently developing danuglipron, another oral drug for diabetes and weight loss. The company recently published a study in the journal JAMA network open as for a tablet twice a day which is said to be taken with food, which is different from oral forms of semaglutide.

Similarly, for semaglutide, this drug mimics GLP-1 to not only help regulate insulin, but also tell the brain that the stomach is full and help regulate weight loss.

While these drugs are compelling, not all of them are the perfect fit for them.

The best candidates for this drug are patients with a BMI greater than 30 or a BMI greater than 27 plus an obesity-related comorbidity such as type 2 diabetes, hypertension, hyperlipidemia, obstructive sleep apnea or fatty liver, Takkouche explained.

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 it at RajivBahlMD.