New Weight Loss Pill! What you need to know.

There has been a lot of excitement in the news about the first-ever approved GLP1- agonist pill. So, what are we talking about, and is it as exciting as it sounds?

As a reminder, GLP1-agonists are the category of drugs that include Ozempic, Mounjaro, Zepbound and Wegovy. They are used for diabetes and weight loss, and, in recent times have a growing number of indications, including for liver disease, kidney disease and heart disease with many more possible indications on the horizon. These drugs help enhance the actions of GLP1, a gut hormone that responds to food. The first GLP1 agonist, exenatide, was approved in 2005. It was used for diabetes. GLP1 agonists help to regulate natural insulin secretion, as well as slowing the food transit and carb absorption in the gut. They are excellent glucose regulators. These drugs also have the benefit of working in response to the glucose that is in your blood, so if you don’t have high blood sugars, they will not make you crash.

In 2014, the first GLP1 agonist was approved specifically for weight loss.  This drug was Saxenda (liraglutide), a daily injection that had already been on the market for diabetes as Victoza since 2010. GLP1 agonists work on the hunger center in the hypothalamus in the brain, they shut down the hunger signal. Patients taking these drugs fill up faster, and food is “off their brain”, people describe less cravings, a quieting of the food noise.

We have right now 2 major GLP1 agonist drugs that we are using, semaglutide (Wegovy, Ryblesus and Ozempic) and tirzepatide (Mounjaro, Zepbound).

So what is this new pill? It is a pill form of Wegovy, a weekly injectable that has been available since 2021 for weight loss, and since 2017 for diabetes. We have had a pill form called Rybelsus, but this was indicated for diabetes and did not reach the same potency. Here is what we know about oral Wegovy:

-          It is a reformulated oral semaglutide, the full dose can reach a potency close to injectable Wegovy

-          At full dose, studies showed an average weight loss of 13.7%

-          It needs to be taken on an empty stomach, with small amounts of water, and you must wait at least 30 minutes to eat

-          It offers the lowest cash prices available for GLP1 agonists, starting at $199/month

Why we’re excited about it: it will be cheaper, it offers an alternative to patients with needle phobia (fear of injections).

Why we’re not that excited about it:

-          The logistics around how you must take it, and waiting to eat and take other medications can get complicated

-          Semaglutide tends to have more side effects than tirzepatide

-          It’s not as potent as tirzepatide, which averages around 20-25% weight loss

The take home message: Oral Wegovy will have a role to play for sure. More options for weight loss are always a good thing; it creates competition and allows us to individualize care. However, the news reports around oral Wegovy have been misleading, it is not totally new or groundbreaking. For most patients, it likely would not be a first choice but there will be situations where it is a reasonable option.