Wegovy Shots and Daily Pills May Treat Obesity

What if managing obesity was as simple as swallowing a pill?
That’s a notion that has long sparked hope for many of the more than 40% of Americans who are classified as obese—as well as criticism from those who urge for greater weight acceptance. It might happen soon.

According to the final results of two trials announced, high-dose oral versions of the pharmaceutical in the weight-loss treatment Wegovy may work as well as the popular injections when it comes to losing weight and improving health. The potent medications also appear to help those with diabetes, who are infamous for having difficulty losing weight.

Novo Nordisk intends to apply to the US Food and Drug Administration for approval of the pills later this year.

“If you ask people a random question, ‘Would you rather take a pill or an injection?’ People overwhelmingly prefer a pill,” said Dr. Daniel Bessesen, chief of endocrinology at Denver Health, who treats patients with obesity but was not involved in the new research.

That’s assuming, Bessesen said, that both ways to take the medications are equally effective, available and affordable. “Those are the most important factors for people,” he said.

Other weight-loss medications have been on the market, but none have achieved the significant reductions seen with injectable treatments like Wegovy. People suffering from obesity will be “thrilled” to have an oral option that is as successful, according to Dr. Katherine Saunders, clinical professor of medicine at Weill Cornell Health and co-founder of Intellihealth, a weight-loss clinic.

Rybelsus, an oral form of semaglutide, the same pharmaceutical used in the diabetic drugs Ozempic and Wegovy, is already available from Novo Nordisk. It is available in doses of up to 14 milligrams.

However, findings from two gold-standard trials presented at the American Diabetes Association’s annual meeting examined how oral semaglutide doses as high as 25 milligrams and 50 milligrams worked to reduce weight and improve blood sugar and other health markers.

A 16-month research of over 1,600 persons who were overweight or obese and already being treated for Type 2 diabetes discovered that the high-dosage daily pills considerably lower blood sugar levels compared to the regular dose of Rybelsus. The larger doses resulted in weight reduction of between 15 and 20 pounds from a baseline weight of 212 pounds, compared to roughly 10 pounds on the lower dose.

Another 16-month study of over 660 adults with obesity or overweight and at least one related disease but no diabetes discovered that the 50-milligram daily pill helped people lose an average of about 15% of their body weight, or about 35 pounds, compared to about 6 pounds with a dummy pill, or placebo.

According to the study’s authors, this is “notably consistent” with the weight loss induced by weekly shots of the highest dose of Wegovy.

However, there were some unintended consequences. Approximately 80% of patients who received any dose of oral semaglutide suffered mild to moderate digestive issues including as nausea, constipation, and diarrhea.

There was evidence of greater frequencies of benign tumors in persons who received the medicine vs a placebo in the 50-milligram obesity trial. Furthermore, almost 13% of those who took the medicine experienced “altered skin sensation” such as tingling or increased sensitivity.

Experts expect that the pills will be popular, particularly among patients who want to lose weight but are afraid of needles. In addition, tablets are more portable than injectable pens and do not need to be refrigerated.

But, according to Dr. Fatima Cody Stanford, an obesity medicine expert at Massachusetts General Hospital, the pills aren’t necessarily a better option for the hundreds of thousands of people presently on injectable equivalents like Ozempic or Wegovy.

“I don’t find significant hesitancy surrounding receiving an injection,” she said. “A lot of people like the ease of taking a medication once a week.”

Furthermore, she believes that some patients may prefer injections to the new pills, which must be taken 30 minutes before eating or drinking in the morning.

Paul Morer, 56, of a New Jersey hospital system, shed 85 pounds with Wegovy and intends to lose another 30. Even if tablets were available, he said he would probably continue with the weekly injections.

“I do it on Saturday morning. It’s part of my routine,” he said. “I don’t even feel the needle. It’s a non-issue.”

Some detractors are also concerned that a pill will put pressure on fat individuals to use it, increasing social stigma against people who can’t—or don’t want to—lose weight, according to Tigress Osborn, chair of the National Association to Advance Fat Acceptance.

“There is no escape from the narrative that your body is wrong and it should change,” Osborn said.

Nonetheless, Novo Nordisk is betting on the success of a higher-dose medication to treat diabetes and obesity. Rybelsus sales were over $1.63 billion last year, more than doubling the forecast for 2021.

Other companies are developing oral versions of medications that are equally effective as Eli Lilly and Co.’s Mounjaro—an injectable diabetes drug that is expected to be licensed for weight loss soon. Lilly researchers announced good mid-stage trial findings for orforglipron, an oral medication used to treat obese or overweight patients with and without diabetes.

Pfizer has also announced mid-stage data for dangulgipron, an oral diabetic medication that is taken twice daily with food.

Officials at Novo Nordisk said it is too early to speculate on the price of the company’s high-dose oral pills or how the company plans to ensure adequate manufacturing capacity to fulfill demand. Despite its growing popularity, Wegovy injectable doses will be in short supply until at least September, according to company executives.

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