Evidence-informed guidance for the clinical use of oral semaglutide in obesity management.

“Evidence-informed guidance for the clinical use of oral semaglutide in obesity management. Rubino D(1), Wharton S(2)(3)(4), Knight MG(5), Aroda VR(6). Author information: (1)Washington Center for Weight Management and Research, Arlington, VA, USA. (2)Department of Medicine, University of Toronto, Toronto, ON, Canada. (3)Department of Medicine, McMaster University, Hamilton, ON, Canada. (4)Wharton Medical Clinic Weight & Diabetes Management, Burlington, ON, Canada. (5)Department of Medicine, The George Washington University, Washington, DC, USA. (6)Division of Endocrinology, Diabetes, and Hypertension Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA. Oral semaglutide, the first oral glucagon-like peptide-1 (GLP-1) receptor agonist therapy approved for the treatment of type 2 diabetes, is now approved for obesity management and cardiovascular risk reduction in adults, demonstrating weight loss comparable to that of subcutaneous GLP-1 therapies, alongside improvements in cardiometabolic risk factors. The availability of oral semaglutide for the treatment of obesity provides healthcare professionals with additional opportunities to individualize therapy based on patient preferences, lifestyle, and clinical circumstances. However, the oral semaglutide formulation requires specific administration conditions to optimize absorption and effectiveness. Notably, oral semaglutide tablets should be taken first thing in the morning on an empty stomach with no more than half a glass of plain water (up to 120 mL or 4 fl oz), followed by 30 min before eating food, drinking additional fluids, or ingesting other oral medications. Person-centered clinical discussions between healthcare professionals (HCPs) and patients prior to treatment initiation are important to ensure patients understand administration requirements and why they are necessary, establish realistic expectations for obesity treatment targets, and cover approaches to maintain adherence. HCP-patient consultations should also include discussion of strategies to help patients minimize, prepare for, and manage adverse events. In this article, we provide practical guidance for incorporating oral semaglutide into obesity management, drawing on evidence from clinical trials, including the OASIS 4 trial, and the authors' clinical insights. Plain Language Summary: Glucagon-like peptide-1 receptor agonists (GLP-1RAs) are medications that are prescribed for the treatment of obesity to help people lose weight by reducing their appetite and feelings of hunger. Most GLP-1RAs are injected into the fatty layer of tissue below the skin, which helps the body absorb the medication into the bloodstream. The GLP-1RA semaglutide has been available in an injectable format for the treatment of obesity for several years and is now also available as a tablet for adults who prefer not to use injections. In clinical trials, people who used the tablet form of semaglutide had similar weight loss to people who used injectable semaglutide. Semaglutide tablets have been designed in a way that resists break down by stomach acid, allowing more of the medication to be absorbed into the body, but there are important steps to follow when taking the tablet to ensure the medication works as well as possible. Based on learnings from clinical trials and the clinical experience of the authors, this article provides practical advice to support healthcare professionals in guiding their patients through these steps. It also covers important topics to discuss with patients before they start taking semaglutide tablets, including possible changes to how they take other medications, how to limit and manage potential side effects, and ways for patients to stay consistent with their treatment schedule.”