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September 2020

First oral GLP-1 receptor agonist launched

The first oral version of the GLP-1 receptor agonist, semaglutide, has been launched in the UK for the treatment of type 2 diabetes.

Until now semaglutide was only available as an injectable therapy, which has deterred patients from accepting or adhering to treatment, and put clinicians off prescribing it because of the time needed to train patients to self-administer injections.

It has taken 15 years of research to formulate an oral version of semaglutide, because, as a protein-based treatment, it is broken down by stomach acid. The drug is now co-formulated with an absorption enhancer to allow it to be taken orally and absorbed from the stomach.

Studies have shown that almost half of UK GPs find the injectable route of administration was a barrier to prescribing a GLP-1 RA. The oral option is predicted to make it easier for clinicians to offer without the need for a face to face consultation.

Hayley Lewis, Primary Care Practice Research Nurse with a special interest in diabetes, Wellingborough, said: ‘Oral semaglutide could make it easier and quicker for patients requiring treatment intensification to be initiated on a GLP-1 RA in primary care, without the need to teach injection technique. This could also make it easier for diabetes nurses to support their patients in adhering to treatment to achieve their target blood sugar and weight, as injectables are often a reason for non-adherence. This is especially important in light of COVID-19, with the increased need to conduct appointments virtually.’

Marketed as Rybelsus®, oral semaglutide 14mg once daily demonstrated significantly greater HbA1c reduction at one year, with the additional benefit of consistent weight reduction, versus other treatments used in the UK, including sitagliptin, empagliflozin and liraglutide. Around 70% of patients treated with oral semaglutide achieved target blood HbA1c. Currently around 40% of adults with type 2 diabetes in the UK do not achieve this target, increasing their risk of diabetes-related complications.

In the PIONEER 6 cardiovascular outcomes trial*, oral semaglutide was shown to have a strong signal for reduction in cardiovascular mortality rates.

*Husain et al. N Engl J Med 2019;381:841-51

Practice Nurse 2020;50(7):8