Troy, a man in his mid-40s, was diagnosed with type 2 diabetes. Despite attempts to improve his condition through diet, exercise, and traditional medications like metformin, his A1C levels remained high. Seeking better control, Troy’s healthcare provider added RYBELSUS® to his treatment regimen. Initially starting with a 3 mg dose, Troy gradually increased to 7 mg and eventually 14 mg to achieve his A1C goal.

Troy discovered that integrating RYBELSUS® into his diabetes care routine was a game-changer. This medication, combined with his commitment to a healthy lifestyle through diet and exercise, has given him a newfound sense of control over managing his condition.

The emergence of Rybelsus made headlines in the realm of diabetes, especially with the many benefits and innovations it introduced. Let us find out how this first orally administered GLP-1 receptor agonist changed the landscape of diabetes treatment.

What is Rybelsus?

In 2019, the FDA approved Rybelsus® (semaglutide) tablets by Novo Nordisk for adults with type 2 diabetes, marking the first oral GLP-1 receptor agonist available. This innovation offers an alternative for individuals unable to reach their A1C goals with existing treatments. The approval, based on comprehensive PIONEER clinical trials, demonstrated Rybelsus®’s efficacy in reducing A1C levels and secondary benefits in weight reduction.

Rybelsus operates through a mechanism that stimulates GLP-1 receptors, thereby promoting insulin secretion, inhibiting glucagon release, and slowing gastric emptying. It stands out due to its oral formulation, differing from other variations that necessitate injection.

Although Rybelsus is effective in its field, it is not the first-choice medicine for treating diabetes. It’s also not recommended for individuals who have had pancreatitis, those with type 1 diabetes, or diabetic ketoacidosis, and its safety and effectiveness are unknown in children under 18 years old.

Clinical Trials and Efficacy

Trials evaluating the effectiveness of oral semaglutide (Rybelsus) showcased favorable outcomes by reducing A1C levels and body weight among individuals diagnosed with type 2 diabetes. Compared to a placebo, oral semaglutide dosages ranging from 3 mg, 7 mg, and 14 mg demonstrated significant decreases in both A1C levels and body weight. The 3 mg dose was for initial treatment, while the focus was primarily on the 7 mg and 14 mg doses for maintaining glycemic control.

Studies such as PIONEER 1, 2, 3, 4, and 5 showcased the superiority of oral semaglutide over placebo or other active agents like liraglutide, empagliflozin, and sitagliptin in reducing A1C levels. Notably, the 14 mg dose consistently exhibited better glycemic control compared to placebo and active comparators across various patient populations and treatment lines.

Furthermore, across the PIONEER studies, a higher proportion of patients obtained the target A1C level of less than 7.0% with oral semaglutide (7 mg and 14 mg) compared to placebo and other active treatments. These positive outcomes were generally sustained or improved throughout the trial durations.

Regarding the administration route, despite variability in plasma concentrations, the oral formulation of semaglutide (7 mg and 14 mg) showed efficacy and tolerability comparable to the injectable form (0.5 mg and 1.0 mg). Analyses combining data from the SUSTAIN and PIONEER trials showed that the efficacy and tolerability exhibited similar exposure-response relationships, regardless of whether semaglutide was administered orally or via injection.

Rybelsus as a Game-Changer

Dr. Vanita R. Aroda, MD, who holds the position of Director of Diabetes Clinical Research at Brigham and Women’s Hospital in Boston, MA, and plays a pivotal role in the PIONEER clinical trials, highlighted the limited adoption of GLP-1 receptor agonists, despite their demonstrated effectiveness in managing type 2 diabetes. This underutilization partly stems from their availability only in injectable form until now.

She also added, “The availability of an oral GLP-1 receptor agonist represents a significant development, and primary care providers, specialists, and patients alike may now be more receptive to the use of a GLP-1 therapy to help them achieve their blood sugar goals.”

Rybelsus®’s introduction holds several advantages over injectable counterparts. These include enhanced patient convenience, ease of administration without the need for needles, and improved acceptance and adherence to treatment regimens. Additionally, the oral form may offer greater flexibility in dosing schedules.

Rybelsus®’s unique formulation might enable healthcare providers to personalize treatment strategies more effectively, considering individual patient preferences, lifestyle factors, and treatment goals. It could also inspire further innovations in oral drug delivery systems for other diabetes medications, leading to a more diverse array of oral treatment options.

Todd Hobbs, Novo Nordisk’s vice president and U.S. chief medical officer, highlighted, “People living with type 2 diabetes deserve more innovation, research, and support to help them achieve their individual A1C goals. With Rybelsus®, we have the opportunity to expand the use of effective GLP-1 receptor agonist therapy by providing adults with type 2 diabetes an oral medication which was previously only available as an injection to help with managing their blood sugar.”