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ForumsOral GLP-1 AgonistsOral vs injectable GLP-1: bioavailability and efficacy comparison — what worked for you?

Oral vs injectable GLP-1: bioavailability and efficacy comparison — what worked for you?

TinaHashiRN Thu, May 2, 2024 at 8:46 PM 17 replies 2,275 viewsPage 1 of 4
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TinaHashiRN
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Sep 2024
Raleigh, NC
May 2, 2024 at 8:46 PM#1

Reading about receptor desensitisation and trying to work out which of the effects adapt over time and which do not, because people clearly experience both.

What would genuinely help is knowing which effects tachyphylax and which persist, because the answer explains why tolerability improves while the appetite effect keeps working.

I would rather have one careful answer than five confident ones.

39 9SarahChen_PharmD, sarah.morrison, NeuroNate and 36 others
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COA_Karl
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Jan 2024
Pennsylvania
May 2, 2024 at 9:07 PM#2
TinaHashiRN said:
Reading about receptor desensitisation and trying to work out which of the effects adapt over time and which do not, because people clearly experience…

Amycretin (AMY/GLP-1 dual agonist) emerging data relevant to the pharmacology: Phase 1 showed -13.1% body weight at only 12 weeks, the fastest trajectory ever seen for an anti-obesity agent[1].

Amylin receptor agonism enhances satiety signaling through the area postrema and reduces glucagon secretion. Combined with GLP-1R agonism, this dual mechanism may produce even greater efficacy than current agents.

Early-stage data — interpret with caution. But the trajectory is extraordinary.

References:
[1] Novo Nordisk investor presentation, September 2023.
38 8jim_asheville, matt_MKE, Dr.ReproEndo and 35 others
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SallyK_inj
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Iowa
May 2, 2024 at 9:28 PM#3
COA_Karl said:
Amycretin (AMY/GLP-1 dual agonist) emerging data relevant to the pharmacology: Phase 1 showed -13.1% body weight at only 12 weeks, the fastest…

No disagreement with COA_Karl. One condition attached. The mechanism is more central than most summaries suggest. Receptor agonism in the arcuate nucleus activates POMC neurons and inhibits AgRP/NPY signalling, and the downstream MC4R pathway is the same one disrupted in monogenic obesity — convergent genetic evidence that the target is the right one. Peripherally there is glucose-dependent insulin secretion, glucagon suppression and delayed gastric emptying, but the gastric component largely adapts over months while the central effect persists, which is why the durable effect is appetite rather than fullness.

37 7oliver_london, tane_welly, Dr.PathRoch and 34 others
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sean_dublin
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Nov 2024
Dublin, IE
May 2, 2024 at 9:49 PM#4
TinaHashiRN said:
Reading about receptor desensitisation and trying to work out which of the effects adapt over time and which do not, because people clearly experience…

This is my experience too, for whatever a second data point is worth. Nothing to add that would improve it.

36 6NurseLeah_Nash, gary_naperville, sean_dublin and 33 others
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Dr.MetabolicMD
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Rochester, MN
May 2, 2024 at 11:41 PM#5

Clinical perspective, offered as context rather than as advice.

Semaglutide structural biology relevant to the pharmacology: semaglutide is a 31-amino acid peptide with 94% homology to native GLP-1(7-36). Three key modifications enable its pharmacokinetic profile:

  1. Aib8 substitution: DPP-4 resistance (prevents enzymatic degradation)
  2. Arg34 substitution: improved chemical stability
  3. C18 fatty diacid at Lys26: albumin binding → long half-life

These three modifications transform a peptide with a 2-minute half-life (native GLP-1) into one with a 168-hour half-life (semaglutide). A masterclass in peptide engineering.

35 5GenomicsKate, Dr.ObesityMed, HealthEcon_DC and 32 others
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