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Evidence-based GLP-1 & peptide discussion since 2023
ForumsOral GLP-1 AgonistsHas anyone dealt with dropped my rybelsus in the toilet this morning - worst day?

Has anyone dealt with dropped my rybelsus in the toilet this morning - worst day?

MASHdoc_SA Tue, Jul 9, 2024 at 9:49 AM 41 replies 2,586 viewsPage 1 of 9
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MASHdoc_SA
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San Antonio, TX
Jul 9, 2024 at 9:49 AM#1

Read the primary source rather than the write-up and the two do not agree, so here is what is actually in it.

The OASIS programme put 50mg oral in the same territory as 2.4mg injectable — around 15% mean weight loss — but it needed a dose 20 times larger to get there because almost none of the tablet is absorbed. The dose numbers are not comparable across routes and quoting them side by side confuses people.

Where I think it is weakest: the completion rate deserves as much attention as the headline, because a large effect among those who finished is a different claim from a large effect among those enrolled.

The question I want answered is how much of the oral variability is the SNAC absorption window and how much is dose, because the two get conflated constantly. I would rather have one careful answer than five confident ones.

Note on sourcing:
Figures above are from the primary publication rather than the press summary. If a number here disagrees with one you have, post yours and we will work out which of us is reading a secondary source.
41 11TirzTom, TrialTracker_MD, JennaRN and 38 others
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JessicaH_TX
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Jul 9, 2024 at 9:56 AM#2
MASHdoc_SA said:
The OASIS programme put 50mg oral in the same territory as 2.4mg injectable — around 15% mean weight loss — but it needed a dose 20 times larger to…

No disagreement with MASHdoc_SA. One condition attached. Oral semaglutide is absorbed in the stomach with the help of SNAC, which locally raises pH and protects the peptide long enough to cross. That mechanism is fragile: bioavailability is roughly 1% and highly sensitive to gastric contents, so a mouthful of coffee genuinely changes the exposure. This is why the label wants 30 minutes and no more than half a glass of plain water.

I would rather be corrected than agreed with, if it comes to it.

Last edited: Jul 9, 2024 at 1:56 PM
40 10sarah_TO, wendy_avl, jason_paloalto and 37 others
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Dr.PainCLE
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Cleveland, OH
Jul 9, 2024 at 10:03 AM#3
MASHdoc_SA said:
The OASIS programme put 50mg oral in the same territory as 2.4mg injectable — around 15% mean weight loss — but it needed a dose 20 times larger to…

I do not accept that the fasting window is a minor inconvenience. Adherence data on daily orals with timing requirements is consistently worse than weekly injections, and a drug you take imperfectly is a lower dose than the one on the box.

39 9oliver_london, tane_welly, Dr.PathRoch and 36 others
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Dr.ReproEndo
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Jul 9, 2024 at 10:10 AM#4

Short answer first, then the reasoning. Orforglipron is the more interesting oral story because it is not a peptide at all. Being a small molecule it does not need SNAC, does not need the fasting window, and has oral bioavailability in the tens of percent rather than about one.

Happy to go further on any of that.

38 8GraceAZ_72, carl_compliance, DanielChem_CHI and 35 others
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LeilaHI
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Honolulu, HI
Jul 9, 2024 at 10:44 AM#5
JessicaH_TX said:
Oral semaglutide is absorbed in the stomach with the help of SNAC, which locally raises pH and protects the peptide long enough to cross.

Second this.

Last edited: Jul 9, 2024 at 3:44 PM
37 7amsterdam_pete, LondonLisa, mike_nyc and 34 others
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