Can a patient do a direct switch from Saxenda (liraglutide) to Ozempic (semaglutide)?

Direct Switch from Saxenda to Ozempic

Yes, a direct switch from Saxenda (liraglutide 3.0 mg) to Ozempic (semaglutide) can be performed safely and effectively without a washout period, as both are GLP-1 receptor agonists with similar mechanisms of action and safety profiles. 1

Evidence Supporting Direct Switching

Real-World Effectiveness Data

• The REALISE-DM study demonstrated that patients with type 2 diabetes who switched directly from liraglutide to semaglutide achieved significant additional benefits, with mean HbA1c reductions of 0.65% and weight loss of 1.69 kg at 6 months post-switch 1

• Direct switching was well tolerated, with only 11.6% of patients developing gastrointestinal side effects after the switch, and the majority of patients tolerating semaglutide well 1

• In comparative trials, semaglutide demonstrated superior weight loss compared to liraglutide, with mean weight reductions of -15.8% versus -6.4% respectively over 68 weeks 2

Guideline Support for GLP-1 RA Switching

• The 2019 ESC/EASD guidelines recommend both liraglutide and semaglutide for patients with type 2 diabetes and cardiovascular disease or high cardiovascular risk to reduce cardiovascular events 3

• The American Diabetes Association recognizes both medications as effective glucose-lowering agents with weight management benefits, supporting their interchangeable use based on clinical response 3

Practical Switching Protocol

Dosing Initiation After Switch

• Stop liraglutide 3.0 mg and immediately start semaglutide at 0.25 mg once weekly for the first 4 weeks 1

• Escalate to semaglutide 0.5 mg weekly after 4 weeks, then to 1.0 mg weekly after another 4 weeks if additional glycemic control or weight loss is needed 3

• For patients using Saxenda for weight management, the target maintenance dose of Ozempic is typically 1.0 mg weekly, though 2.0 mg weekly is available if greater efficacy is required 2

Expected Outcomes

• Patients should anticipate further weight loss and improved glycemic control compared to their baseline on liraglutide 1, 2

• Weight loss with semaglutide 0.5 mg weekly is comparable to liraglutide 3.0 mg daily at 3 months, with higher doses of semaglutide providing superior results 4

• Achievement of ≥10% weight loss occurs in 70.9% of patients on semaglutide 2.4 mg versus 25.6% on liraglutide 3.0 mg 2

Safety Considerations and Monitoring

Gastrointestinal Tolerability

• The most common adverse events are dose-related gastrointestinal symptoms, primarily nausea, which are typical of the GLP-1 receptor agonist class 5

• Gastrointestinal side effects occur in approximately 84% of patients on semaglutide, similar to the 82.7% rate with liraglutide 2

• These symptoms are generally transient and can be managed with slower dose escalation if needed 3

Contraindications and Warnings

• Both medications carry warnings for thyroid C-cell tumors (observed in rodents) and are contraindicated in patients with personal or family history of medullary thyroid carcinoma or multiple endocrine neoplasia type 2 3

• Monitor for pancreatitis symptoms and acute renal failure, particularly in patients with pre-existing kidney disease 3

• Avoid hypoglycemia by adjusting doses of concomitant insulin or sulfonylureas if used 3

Clinical Rationale for Switching

When to Consider Switching

• Inadequate weight loss on liraglutide (less than 4% at 16 weeks per FDA guidance) 3

• Desire for once-weekly versus daily injections to improve adherence 2

• Need for greater glycemic control or additional weight loss beyond what liraglutide provides 1

Pharmacologic Advantages

• Semaglutide has a longer half-life allowing once-weekly dosing compared to daily liraglutide injections 2

• Both medications have established cardiovascular safety, with semaglutide showing MACE reduction in cardiovascular outcomes trials 6

• The medications should not be combined with DPP-4 inhibitors or other GLP-1 receptor agonists 6

Important Caveats

• Treatment discontinuation rates were lower with semaglutide (13.5%) compared to liraglutide (27.6%) in head-to-head trials, suggesting better long-term tolerability 2

• Insurance coverage and formulary restrictions may influence medication selection, as both agents are expensive with monthly costs exceeding $900-1,100 3, 6

• Patients should be counseled that the switch is expected to provide additional therapeutic benefit rather than simply maintaining current effects 1