A pill instead of injection - A 2020 study on Rybelsus

A pill instead of injection - A 2020 study on Rybelsus
Photo by Scott Graham on Unsplash

Rybelsus is a form of Semaglutide that you can take as a pill, rather than injection. If you're not familiar with Semaglutide, it's one of the GLP1 Receptor Agonist class of drugs that are taking the world by storm right now (Ozempic, Wegovy, and Rybelsus are all formulations of Semaglutide).

Don't know what a GLP1 Receptor Agonist is, or how drugs like Ozempic, Mounjaro, Wegovy, or Zepbound work?

Check out our quick explainer
Box of Rybelsus (source: PhoenixPharma.co.uk)

So does it work just as well as an injection? As you might expect, the answer is no, but it may work very well for people who choose to take it, and are fine with a relatively lower dose.

Dosages of Rybelsus versus Injection (ex. Ozempic, Mounjaro)

Rybelsus has a much higher dosage than the injectable form of Semaglutide (ex. Ozempic), but don't let that confuse you – the entirety of the dose does not get used effectively by your body.

  • Rybelsus dosages: 3mg, 7mg, 14mg, to 50mg
  • Ozempic dosages: 0.25mg, 0.5mg, 1mg, to 2mg

That's a HUGE difference in dosages, but this is necessary because Rybelsus is mostly burned in other places of your body – the majority of the dosage is actually wasted.

Research: A small trial in Europe

There's one trial that is very specifically about Rybelsus, but unfortunately has a very small participant size.

Effects of oral semaglutide on energy intake, food preference, appetite, control of eating and body weight in subjects with type 2 diabetes
To evaluate the effect of oral semaglutide on energy intake and appetite in subjects with type 2 diabetes (T2D).In this randomized, double‐blind, placebo‐controlled, two‐period cross‐over trial, 15 subjects with T2D received…
This study was funded by Novo Nordisk (as many of the Semaglutide studies are). It's important to always consider bias and possible effects of bias on reported study/trial/research results.

It was published in the Wiley Diabetes Obesity and Metabolism journal so it's passed some sniff tests, but there's only so much you can realistically take from such a small study.

Reading through the results, here's what popped out:

  • Over 12 weeks participants had an average of 2.7kg down with no significant changes to lifestyle
  • The study only had 15 participants, of which only 13 were actually able to be evaluated
  • Participants took Rybelsus once daily

The most important piece is here:

Fewer food cravings and better eating control were seen with oral semaglutide versus placebo.

As many people pursue Semaglutide and other GLP1 RAs in order to lose a relatively small amount of weight, it might be the case that simply achieving better eating control with a daily pill might be well within reach of more people than doing a full on injection, even if more rarely.

So, clearly, Rybelsus is effective – likely less so than the injected Ozempic and other alternatives, but it's definitely a less invasive (for those that dislike injections) way to start a regimen of GLP1 Receptor Agonists.

Research: OASIS-1, over 700 people in Asia, Europe and North America

This study was funded by Novo Nordisk (as many of the Semaglutide studies are). It's important to always consider bias and possible effects of bias on reported study/trial/research results.

Published in the Lancet, the OASIS-1 Trial is great study that showcases the possibilities of 50mg dose of oral semaglutide (i.e. Rybelsus).

The results of this study were much more impressive, and it also ran for much longer. The important information is:

The estimated mean bodyweight change from baseline to week 68 was –15·1%

They were able to break down the mean body weight loss by amount and how many people reached it over the 68 weeks, and the vast majority of people lost at least 5% of their body weight, on average.

The weight loss wasn't without risks though:

Gastrointestinal adverse events (mostly mild to moderate) were reported in 268 (80%) participants with oral semaglutide 50 mg and 154 (46%) with placebo.

Clearly, there is a marked rise in gastrointestinal issues with people on oral semaglutide versus placebo.

If you're interested in reading more about the adverse effects you might enjoy our other article:

Are GLP1 drugs (Semaglutide) safe?
Drugs like Ozempic, Mounjaro, Wegovy and others are helping people beat type 2 Diabetes and lose weight, but are these drugs safe? 💡Don’t know what “GLP1” means? Check out our explainer article on “GLP1 Agonists” for an easy to understand explanation. What does “safe” mean? Before we can talk about

So what?

For people considering starting a regimen of GLP1 Receptor Agonist drugs who aren't too fond of needles, there's an option in Rybelsus that might be a bit less invasive.

As always, the best way to start a regimen of any medical treatment is to talk to your doctor or primary care physician in order to find out your risk factors, and what works best for your body.