Until recently, the stomach was a “dead zone” for GLP-1s because stomach acid and digestive enzymes break down peptides before the body can absorb all of them. New oral GLP-1s are designed to protect peptides, the active ingredients in these medications, so they can survive the trip through your digestive tract.
Based on clinical trials, the new semaglutide (Wegovy) pill has many of the same benefits as semaglutide that you inject into your body.
In the clinical trial that the FDA considered to approve Wegovy pills, adults taking 25 milligrams (mg) of the pills lost an average of 13.6 percent of their body weight over 64 weeks, compared with 2.2 percent in a placebo group.
In comparison, adults taking weekly injections of 2.4 mg of semaglutide lost an average of 14.9 percent of their body weight over 68 weeks, compared with 2.4 percent for the placebo group.
The FDA approved the 25 mg pills for weight management because of how similar they were to injections in terms of weight loss and safety, says W. Timothy Garvey, MD, a professor of medicine at the University of Alabama at Birmingham.
Why does it take a 25 mg daily pill to do the same job as a 2.4 mg weekly injection? The higher dose ensures enough of the drug survives the trip through your system to be effective. The actual effect of the medication is nearly the same.
“The absorption of the oral med from the [gastrointestinal] tract into the bloodstream is poor, such that the amount of medication entering the bloodstream is similar for the oral and injectable,” Dr. Garvey says.
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