Oral semaglutide is used for weight loss, but without scientific proof

The use of subcutaneous applications of semaglutide for the treatment of overweight and obesity has raised the debate whether the substance in tablet form can offer a similar effect.

The formula in capsules, however, is not available in the doses indicated for weight loss. The product available on the market, sold under the trade name Rybelsus, should only be used for the indicated purpose, the treatment of diabetes mellitus, according to specialists consulted by Sheet.

Professionals point out that, despite being the same substance (a form synthesized in the laboratory of a hormone called GLP-1), there is a lack of studies that establish safety standards for the use of the pill as a medication for weight loss.

Endocrinologist Paulo Augusto Carvalho Miranda, president of the Brazilian Society of Endocrinology and Metabology (SBEM) and a specialist in the area, says that only three drugs that have semaglutide as an active ingredient are authorized.

Those strictly indicated for the treatment of diabetes are Rybelsus and Ozempic (weekly subcutaneous application) – used offflabelly for the treatment of obesity. In addition to them, there is Wegovy, released in January by Anvisa (National Health Surveillance Agency) for weight loss and not yet available in pharmacies.

“We had the approval of subcutaneous semaglutide for the treatment of obesity. This medication, trade name Wegovy, still undergoes a final regulatory process, with pricing, release of devices”, says Miranda.

According to the president of SBEM, the essential difference between the drug formats is the absorption technology.

“Semaglutide is a protein molecule, a set of amino acids. In general, most medications with proteins or peptides need to be applied by injection, not passing through the stomach, because it contains enzymes that degrade these molecules”, he says.

Rybelsus has an encapsulation mechanism that allows semaglutide to be absorbed without being damaged by stomach acids, he says. Research proves the efficiency of this medicine in the treatment of diabetes, however, the same does not happen in weight loss.

“We still don’t have any study available showing the efficacy and safety of semaglutide orally for people with obesity, only subcutaneously and in doses different from those currently available for the treatment of type 2 diabetes”, says Miranda.

For the president of SBEM, the results of semaglutide treatment for obesity with the doses studied, which are higher than those available on the Brazilian market for the treatment of diabetes, are promising.

Rodrigo Lamounier, medical coordinator of the Endocrinology service at the Mater Dei Health Network, points out that the variety of formats contributes to more results.

“As a physician, I think it is important to have injectable and oral presentations available, mainly because, depending on the profile of each patient, this can facilitate adherence to treatment, which is always a very important aspect in the care of chronic diseases”, points out the endocrinologist.

Lamounier states that, if on the one hand the oral version can help patients who have problems with needles, on the other hand the weekly frequency of the injectable can be more advantageous for those who already take many daily medications.

The medical literature, according to the coordinator, suggests that for diabetes, the use of oral or injectable medication is similarly effective, especially with regard to glucose reduction.

“With regard to weight reduction, perhaps the injectable application may have a slightly greater effect compared to the oral presentation, but there are not so many studies that have made this comparison, so it is not possible to state this categorically”, highlights the doctor.

Lamounier recommends Rybelsus and Ozempic only for those with diabetes, as the label prescribes, and chooses the medication format by discussing the pros and cons of each with the owner of the prescription.

“The decision is thus shared. The role of the chronic disease doctor is to facilitate understanding and knowledge so that the patient makes the choices that he believes are the most identified with his way of seeing life”, says the coordinator.

In the case of insulin deficiency, there are other issues that clinical practice takes into account, such as the joint use of more than one medication.

Even so, GLP-1, according to Lamounier, improves blood sugar control, reduces the risk of heart disease and the risk of kidney problems, benefits that will soon, with the arrival of the injectable Wegovy on the market, also be able to be replicated in patients who need to lose weight and accumulate other comorbidities.