From the Guidelines
For a patient with type 2 diabetes already on metformin, lisinopril, rosuvastatin, and supplements, oral semaglutide (Rybelsus) would likely be the better option compared to liraglutide (Victoza). Oral semaglutide offers the significant advantage of being taken by mouth once daily, whereas liraglutide requires daily injections. Semaglutide has demonstrated superior glycemic control and weight loss effects compared to liraglutide in clinical studies 1. The recommended starting dose for oral semaglutide is 3mg once daily for one month, then increasing to 7mg daily, and potentially to 14mg daily if needed for glycemic control.
Key Considerations
- The medication should be taken in the morning on an empty stomach with no more than 4 ounces of water, and the patient should wait at least 30 minutes before eating, drinking, or taking other oral medications.
- Common side effects include nausea, vomiting, and diarrhea, which often improve over time 1.
- The patient should continue their metformin as prescribed, as the combination provides complementary mechanisms for controlling blood glucose.
- Regular monitoring of blood glucose levels is important when starting this medication, and the patient should be aware that semaglutide may also provide cardiovascular benefits and further reduce their cardiovascular risk alongside their current lisinopril and rosuvastatin therapy 1.
Clinical Evidence
- The LEADER trial showed that liraglutide reduced the primary composite outcome of cardiovascular death, non-fatal myocardial infarction or stroke by 13% compared to placebo 1.
- The SUSTAIN 6 trial demonstrated that semaglutide reduced the primary outcome of cardiovascular death, non-fatal myocardial infarction or stroke by 26% compared to placebo 1.
- Semaglutide has also been shown to have a favorable weight loss effect and improve lipid profiles, which can further contribute to reducing cardiovascular risk 1.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Comparison of Oral Semaglutide and Liraglutide
- Oral semaglutide has been shown to be effective in reducing glycated haemoglobin (HbA1c) and body weight in patients with type 2 diabetes, with a significant reduction in HbA1c (-1.30% [95%CI: -1.44, -1.16], P < 0.05) and body weight (-3.17 kg [95%CI: -3.89, -2.45], P < 0.05) compared to placebo 2.
- Liraglutide, on the other hand, has been compared to semaglutide in several studies, with results showing that semaglutide is superior to liraglutide in reducing HbA1c and body weight 3.
- A real-world effectiveness analysis of switching from liraglutide or dulaglutide to semaglutide in patients with type 2 diabetes showed that semaglutide caused further reductions in HbA1c and weight, with a mean decrease in HbA1c of 0.65% (7.1 mmol/mol) and a mean weight reduction of 1.69 kg 3.
Efficacy and Safety of Oral Semaglutide
- Oral semaglutide has been shown to be effective and safe in patients with type 2 diabetes, with a similar safety profile to subcutaneous semaglutide 2, 4.
- The most common adverse events associated with oral semaglutide are gastrointestinal disorders, such as nausea, diarrhea, and vomiting 2, 5.
- Oral semaglutide has been shown to be non-inferior to subcutaneous semaglutide and superior to placebo and other GLP-1 RAs in reducing HbA1c and body weight 2.
Patient Selection and Administration
- Oral semaglutide may be a suitable option for patients with type 2 diabetes who are already on metformin and other medications, such as lisinopril and rosuvastatin 4.
- Patients should be instructed to take oral semaglutide on an empty stomach with up to 4 fl oz/120 mL of water, and to wait at least 30 minutes before eating, drinking, or taking other oral medications 4.
- Gradual dose escalation is recommended to minimize the risk of gastrointestinal adverse events 4.