Dr Ian Neeland Explains Why Semaglutide Shortage Impacts Injectable and Not Oral Version

According to Ian Neeland, MD, the shortage of injectable semaglutide as opposed to the oral version may be attributed to the fact that oral semaglutide has not been tested for weight loss indications, leading to less awareness and utilization. Neeland serves as director of cardiovascular prevention and codirector of the Center for Integrated and Novel Approaches in Vascular-Metabolic Disease at the University Hospitals Harrington Heart & Vascular Institute, as well as associate professor of medicine at Case Western Reserve University School of Medicine.

This transcript has been lightly edited for clarity.

Transcript

Why do you think the semaglutide shortage mainly affects the injectable version and not the oral version?

I think 2 reasons. One is that the orals were not tested for the weight loss indication, so there are not weight loss management trials in oral semaglutide as of yet, and so therefore, people just don't have it on their minds—it hasn't been tested, so they don't have it in their minds. But, certainly, there is a weight loss associated with oral semaglutide, although we don't know exactly to what degree compared with injectable semaglutide, that's number 1. Number 2 is that the oral semaglutide—for the same reasons and similar reasons—is just not utilized as much as the injectable type. Although it's certainly been tested for glycemic control and is effective for that, and has been tested for cardiovascular outcomes, and there's actually an ongoing trial looking at oral semaglutide for cardiovascular benefit. It's definitely available, [but] it's kind of been overlooked by most practitioners as an option.

There are a few limitations with oral semaglutide that you don't find with injectable semaglutide. First and foremost, obviously, it's once a day vs once a week. Second of all, you have to take it with a very, very little bit of water and no other medications or food, much like thyroid medication. So the timing of medication can be tricky for people who maybe in the morning aren't as regimented, and they have a difficult time taking different medications at different times, so adherence becomes a problem. And also there are essentially 3 doses at which to treat the patient with, whereas for semaglutide 2.0 there's a little more range of dosing you can do. But it's definitely an appropriate option, a good option, especially for type 2 diabetes management, and potentially off-label for weight loss, although that has not been tested to my knowledge formally in clinical trials.