After the official market entry of "Semaglutide for weight loss" (Novo Nordisk's Wegovy®) in November, another important member of the semaglutide family—oral semaglutide , Rybelsus®—is set to take center stage in clinical practice.

On December 10th, SinoUnited Health officially introduced Rybelsus® and prescribed it to an eligible patient, a mother with a history of type 2 diabetes in her family who needs a change from her current medication, which aren't helping her achieve herglycemic goals.

Compared to injectable medications like Ozempic® (semaglutide once weekly) and Wegovy® (semaglutide once weekly for weight management), Rybelsus® is taken orally once a day. How should it be used? Let's find out.

What kind of medication is Rybelsus®?
Like Ozempic® and Wegovy®, Rybelsus® contains semaglutide as its active ingredient, which is a glucagon-like peptide-1 receptor agonist (GLP-1RA).

GLP-1RAs stimulate natural insulin secretion and slow gastric emptying. They also reduce food intake through central appetite suppression, thereby helping to lower blood glucose. Additionally, they can support weight loss, reduce blood pressure, and improve lipid profiles.

Other GLP-1RAs in the same class include liraglutide, exenatide, and dulaglutide, among others.

Why can Rybelsus® be taken orally?
Rybelsus® contains a special excipient called sodium N-(8-[2-hydroxybenzoyl]amino)caprylate (SNAC). SNAC promotes the absorption of peptide drugs when taken orally.

SNAC elevates local pH by neutralizing gastric acid, protecting semaglutide from enzymatic degradation and helping it remain in a monomeric form for effective absorption. According to reports, SNAC can increase the bioavailability of orally administered semaglutide by about 100-fold.

With this "boost," Rybelsus® is the world's first and currently only oral GLP-1RA, offering patients with diabetes a more convenient and efficient way to benefit from GLP-1RA therapy.

Since all three medications (Ozempic®, Rybelsus®, Wegovy®) contain semaglutide, can they be used interchangeably?
Oral semaglutide was approved in China in January of this year. In simple terms, both Rybelsus® and Ozempic® are indicated for adults with type 2 diabetes, while Wegovy® is approved for body weight management in eligible patients.

Indications at a glance:

Ozempic®: For adults with type 2 diabetes whose blood sugar is inadequately controlled on diet and exercise plus metformin and/or sulfonylureas. It can also reduce the risk of major adverse cardiovascular events (cardiovascular death, nonfatal myocardial infarction, or nonfatal stroke) in adults with type 2 diabetes and cardiovascular disease.

Rybelsus®: For adults with type 2 diabetes as monotherapy or as an add-on to metformin and/or sulfonylureas when diet and exercise alone do not provide adequate glycemic control.

Wegovy®: For long-term weight management in adults (with diet and increased physical activity) who have an initial BMI of ≥30 kg/m² (obese) or ≥27 kg/m² to <30 kg/m² (overweight) and at least one weight-related comorbidity (such as hyperglycemia, hypertension, dyslipidemia, obstructive sleep apnea, or cardiovascular disease).

Who should not use Rybelsus®?

Contraindications: Patients who have a personal or family history of medullary thyroid carcinoma (MTC), multiple endocrine neoplasia syndrome type 2 (MEN 2), or those allergic to the active ingredient or any of the excipients of the drug should not use it.

Pregnancy: Due to limited data, Rybelsus® is not recommended for use during pregnancy. It should be discontinued at least 2 months prior to a planned pregnancy.

Not a Substitute for Insulin: Rybelsus® is not a substitute for insulin and should not be used in patients with type 1 diabetes or for the treatment of diabetic ketoacidosis.

At SinoUnited Health's Endocrinology, Metabolism and Thyroid Center, we provide patients with individualized and comprehensive diagnosis and treatment, as well as complication screening, health education, and convenient online services with scientific and rigorous professionalism. Featuring state-of-the-art medical equipment, this center offers patients warm medical care in a comfortable consultation area, with humanistic care and professional guidance all around.

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