Rybelsus® (semaglutide) will be the first ORAL GLP-1 agonist for type 2 diabetes…it’s a tablet version of injectable Ozempic.
Glucagon-like peptide-1 (GLP-1) is inactivated in the stomach.
That’s why other GLP-1 agonists…Bydureon (exenatide), Trulicity (dulaglutide), Victoza (liraglutide), etc…are injected.
Rybelsus® is formulated to prevent breakdown and improve semaglutide absorption…but it’s challenging to take correctly.
Emphasize that Rybelsus® must be taken DAILY with a sip, or no more than 120 mL, of water…at least 30 minutes before the first food, beverage, or oral meds of the day. Not doing so reduces efficacy.
Keep in mind that Bydureon, Ozempic, and Trulicity are injected WEEKLY…at any time of day, with or without meals.
Also weigh Cardio Vascular (CV) data. So far, evidence isn’t strong enough to say that Rybelsus lowers CV risk in type 2 diabetes patients with CV disease or at high CV risk…even though Ozempic does.
Don’t recommend Rybelsus if a metformin add-on is needed for CV patients. Instead, think of GLP-1 agonists that reduce CV risk…Ozempic®, Trulicity®, or Victoza®.
Or suggest an oral SGLT2 inhibitor that lowers CV risk…Jardiance (empagliflozin) or Invokana (canagliflozin).
Still, expect semaglutide tablets to sound appealing to some patients.
For example, it lowers A1C by about 1% and leads to short-term weight loss of about 2 to 4 kg (5-10 pounds)…similar to most other GLP-1 agonists.
But explain that Rybelsus is titrated monthly, slower than most injectables…in order to reduce GI side effects.
Advise saving Rybelsus for type 2 diabetes patients withOUT CV disease or for those who want an oral med…can manage its tricky administration…and when lower-cost options aren’t the best choice.
For example, consider Rybelsus if a gliptin won’t get the patient to A1C goal…or hypoglycemia or weight gain is a concern with sulfonylureas.