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Is semaglutide indicated for daily use? 

You have probably come across a prescription or a patient asking about daily clicks of a weekly dosage medication, such as semaglutide. Therefore, the question always remains as to whether there is any support in the medical literature for this. The answer is yes!

The use of semaglutide to treat obesity is a well-established approach, as obesity is a major issue. Although the leaflet indicates its weekly use, the investigation of efficacy and safety in comparison with other agents proved to be relevant to explain the daily clicks. 

It is important to highlight that, although research may indicate the effectiveness of Semaglutide, a qualified healthcare professional must guide the decision to use it daily or weekly, taking into account the individual needs of each patient and possible risk factors. Obesity is a complex condition and treatment must be personalized for each individual. 



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Semaglutide in Literature

I have two news. The first is that there are no systematic reviews that prove the daily use of Semaglutide. On the other hand, there are two studies published in important journals such as The Lancet and Diabetes Care, endorsed by the American Diabetes Association._11100000-0000-0000-0000 -000000000111_


Let's go to the studies, the first is theEfficacy and safety of semaglutide compared with liraglutide and placebo for weight loss in patients with obesity: a randomized, double-blind, placebo and active controlled, dose-ranging , phase 2 trial,published on August 16, 2018, in the magazine The Lancet. The initial study, in phase two, wanted to analyze the effect of Semaglutide on daily clicks analyzing doses and side effects. Furthermore, the idea of reducing the dose in the study is to make it easier to withdraw if a serious side effect appears. 

In addition, this study was a randomized, double-blind, placebo-controlled, multicenter, variable-dose phase 2 clinical trial. Thus, eligible participants were adults, without diabetes and with a body mass index (BMI) of 30 kg/m² or more. The researchers randomly assigned participants to intervention treatment groups, with different doses of semaglutide or liraglutide, or to the placebo control group, following a dose-escalation program over time.


Semaglutide vs. Liraglutide

Participants administered all treatments via daily subcutaneous injections. Both participants and researchers were unaware of which specific treatment was being administered, although they knew they were receiving a certain dose. Therefore, the main objective of the study was to evaluate the percentage of weight loss in 52 weeks.

Finally, participants received semaglutide in one of five doses or liraglutide as daily subcutaneous injections. For each active treatment group, there was a placebo control group with the same injection volume and escalation and dosing schedule. 


Efficacy of Semaglutide

In addition, semaglutide was started at 0.05 mg per day and gradually increased to the next dosage every 4 weeks until reaching the final dose. Two additional semaglutide rapid escalation groups (0.3 mg and 0.4 mg) were increased every 2 weeks as an exploration. On the other hand, liraglutide was started at 0.6 mg per day and increased by 0.6 mg per week until reaching 3.0 mg.

Finally, average characteristics at baseline included an age of 47 years, body weight of 111.5 kg, and BMI of 39.3 kg/m². Study results indicated that daily semaglutide is more effective in promoting weight loss than liraglutide. Estimated mean weight loss ranged from -13.8% to -11.2% in Semaglutide groups, compared to -7.8% in the group receiving liraglutide. Furthermore, a greater percentage of participants achieved weight loss of 10% or more with Semaglutide compared to the placebo group.

Regarding tolerability, semaglutide was well tolerated, with common side effects such as nausea. Therefore, these results suggest that semaglutide administered daily may be a more viable option than liraglutide for the treatment of obesity, offering superior efficacy in weight reduction. This is especially true when your patient does not tolerate the beginning of the medication very well and needs adjustment with dose escalation. 


Semaglutide for Diabetic Patients

The other study, A 26-Week Randomized Controlled Trial of Semaglutide Once Daily Versus Liraglutide and Placebo in Patients With Type 2 Diabetes Suboptimally Controlled on Diet and Exercise With or Without Metformin,< /em> published in September 2018 in Diabetes Care,wished to investigate the efficacy and safety of daily use of semaglutide compared to daily use of liraglutide in patients diagnosed with type 2 diabetes.


Type 2 diabetes is a chronic condition that affects the way the body regulates blood glucose levels. Furthermore, both medications, Semaglutide and Liraglutide, belong to a class of medications known as GLP-1 receptor agonists, which are used to help control blood sugar levels in patients with type 2 diabetes. The difference between them is in dosage and half-life. 

Thus, this study was a 26-week, double-blind clinical trial, carried out in several medical centers, with patients diagnosed with type 2 diabetes who had HbA1c levels between 7.0% and 10.0%. Patients were being treated with diet and exercise, with or without metformin. 


Impact of semaglutide on HbA1c levels

For this, participants were randomly distributed into three groups: one group received semaglutide daily, another received liraglutide daily, and a third group received placebo. Thus, within each treatment group, patients were subdivided into four groups with volume-corresponding doses (semaglutide and liraglutide variations). The main objective of this study was to evaluate the change in HbA1c levels from baseline to week 26 of treatment.

Finally, a dose-dependent change in HbA1c was observed with semaglutide, ranging from -21.1% (0.05 mg) to -21.9% (0.3 mg), and with liraglutide , ranging from -20.5% (0.3 mg) to -21.3% (1.8 mg). The change in the placebo group was -20.02%. Gastrointestinal disorders were the most common adverse events with semaglutide and liraglutide, occurring in 32.8-54.0% and 21.9-41.5% of patients, respectively.


Take home message

At the end of your reading, did you realize that these are studies with different scenarios, obesity and type 2 diabetes, but with very similar results? The first fromThe Lancetconcluded that in combination with dietary and physical activity counseling, semaglutide was well tolerated over 52 weeks and demonstrated clinically relevant weight loss compared with placebo in all doses compares to Liraglutide.

The Diabetes Care study concluded that daily Semaglutide at doses of up to 0.3 mg/day resulted in greater reductions in HbA1c compared with liraglutide or placebo, but more frequently high number of gastrointestinal adverse events.


Clinical Practice

Interesting, isn't it? What needs to be well defined is the important consideration: Semaglutide allows dose escalation, which can be useful when patients do not tolerate gastrointestinal adverse events well. In other words, its daily use is indicated for patients who cannot tolerate the maximum dose of 2.4mg weekly, consolidated anti-obesity treatment. This means that treatment can be adjusted according to the patient's tolerance, allowing for a personalized approach for your patient.


References

O’NEIL, Patrick M; BIRKENFELD, Andreas L; MCGOWAN, Barbara; MOSENZON, Ofri; PEDERSEN, Sue D; WHARTON, Sean; CARSON, Charlotte Giwercman; JEPSEN, Cecilie Heerdegen; KABISCH, Maria; WILDING, John P H. Efficacy and safety of semaglutide compared with liraglutide and placebo for weight loss in patients with obesity: a randomized, double-blind, placebo and active controlled, dose-ranging, phase 2 trial. The Lancet, [S.L.], v. 392, no. 10148, p. 637-649, Aug. 2018. Elsevier BV.

LINGVAY, Ildiko; DESOUZA, Cyrus V.; LALIC, Katarina S.; ROSE, Ludger; HANSEN, Thomas; ZACHO, Jeppe; PIEBER, Thomas R.. A 26-Week Randomized Controlled Trial of Semaglutide Once Daily Versus Liraglutide and Placebo in Patients With Type 2 Diabetes Suboptimally Controlled on Diet and Exercise With or Without Metformin. Diabetes Care, [S.L.], v. 41, no. 9, p. 1926-1937, 19 July. 2018. American Diabetes Association.


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