COMMENTARY

Oral Semaglutide a 'PIONEER' in the Treatment of Type 2 Diabetes

Martin Haluzik, MD, DSc

Disclosures

October 19, 2018

Hello. I would like to share with you some interesting developments from the PIONEER 1 program. The PIONEER 1 clinical trial was focused on the new oral GLP-1 receptor agonist semaglutide.[1]

This is one of the most exciting developments in the field of type 2 diabetes because we have not been able to deliver peptides such as GLP-1 receptor agonists orally. This is the first molecule that can be given orally, in contrast to injectables that are currently being used in clinical practice.

This compound is not on the market yet; however, once-weekly injectable semaglutide is available, and it is the most efficacious GLP-1 receptor agonist, improving type 2 diabetes and decreasing body weight.

Oral semaglutide is a pill that patients can take once daily. The most exciting thing about this pill is that it is equally effective as injectable semaglutide.

In the PIONEER 1 trial, oral semaglutide was given to patients with a relatively short history of type 2 diabetes who had been treated with diet and exercise. We found that it was very efficacious. With the highest dose, glycated hemoglobin was decreased by 1.5% from a baseline level of 8%. It is probably the most efficacious oral antidiabetic agent that has ever been used, and may have many important consequences in the future.

Many patients fear injecting medications, leading to a significant dropout rate. Oral semaglutide provides the possibility of overcoming this because you can just adjust the oral medication without adding an injectable, which should significantly improve patient adherence to this medication.

Oral semaglutide also significantly decreases body weight, and it is probably the most efficacious antidiabetic medication for decreasing body weight.

Last, it is very safe. There were no unexpected adverse events. It has a very similar safety profile to other GLP-1 receptor agonists, rarely inducing hypoglycemia.

Some gastrointestinal side effects were observed at a rate similar to those of other GLP-1 receptor agonists, which tend to decrease over time. Oral semaglutide will be a very interesting option for the treatment of type 2 diabetes in the future.

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