Semaglutide has been approved in China. Is the “magic drug for weight loss” really here?

Many friends who want to lose weight must be familiar with semaglutide. This drug can not only be used to treat type 2 diabetes, but is also very effective for obese people to lose weight. Its indication for weight loss in non-diabetic adults was approved in the United States as early as 2021.

The good news is that on June 25, 2024, the "weight loss version" of semaglutide, which is used to improve obesity/overweight in adults, has also been approved by the China National Medical Products Administration.

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So, can the weight loss version of semaglutide be used casually? What are the similarities and differences between it and semaglutide, which is used by type 2 diabetics to lower blood sugar? What should be paid attention to when using it for weight loss? Let's talk about this topic today.

Semaglutide for weight loss

What precautions should be taken when taking the medication?

The weight loss version of semaglutide has been approved in China. What are the precautions when using it for weight loss? Let's talk about 3 points briefly.

First of all, those who are not obese and just want to have a better body may be a little disappointed. Because although we say that semaglutide can be used for weight loss, the use of this drug has a strict range of users. Even the weight loss version of semaglutide has the same applicable population. Only the following two groups of people can consider using semaglutide for weight loss:

Obese people with a body mass index greater than 30.

People with a BMI between 27 and 30 who also have one or more overweight-related comorbidities, such as hyperlipidemia, hypertension, obstructive sleep apnea, and cardiovascular disease.

Only obese or overweight adults who meet the above conditions can use semaglutide to lose weight. People whose body mass index is not over the standard and who just want to be "thin and beautiful" may not be able to get a doctor's prescription.

Secondly, we should pay attention to the adverse reaction risk and tolerance of semaglutide. Although the safety of semaglutide has been extensively clinically verified, its adverse reactions still exist.

The most common of these is gastrointestinal adverse reaction. About 40% of people will experience nausea after using semaglutide, and nearly a quarter of people will experience diarrhea, vomiting, constipation and other adverse reactions. Stomach pain, bloating, belching and other problems are also very common adverse reactions. Although these gastrointestinal adverse reactions are usually mild and most can be gradually tolerated, you should be careful not to increase the dose too quickly to avoid causing more serious adverse reactions and tolerance problems.

In addition, when using semaglutide for weight loss, you also need to pay attention to the possible occurrence of pancreatitis, cholecystitis, and thyroid tumors. These are generally rare, but they are also worth noting.

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Finally, it is important to emphasize that weight loss with semaglutide cannot be achieved by drugs alone. Although a large amount of clinical research data shows that it has a considerable weight loss effect, it is also based on the participants' lifestyle intervention of good diet control and increased exercise.

With good living and eating habits, medications can have a better weight loss effect, better ensure the safety of medications and maintain long-term weight loss effects, and reduce the risk of skin sagging caused by rapid weight loss.

Semaglutide glucose-lowering version and

What’s the difference between the weight loss version?

Some friends say, isn't this the same drug? It's just a different package. This perception is actually biased. Although they are indeed the same drug, they both belong to the GLP-1 receptor agonist class of drugs, and their mechanism of action is to activate the GLP-1 receptor to improve pancreatic secretion, metabolism, delay gastrointestinal emptying, and suppress appetite. But in general, in addition to the differences in the applicable population, the two drugs still have certain differences in dosage, drug packaging form, and drug economy.

In terms of drug dosage, the dosage of the glucose-lowering version of semaglutide is between 0.25mg and 2mg. The dosage should be determined based on the tolerance and glucose-lowering needs of the diabetic patient. It is generally injected once a week, and the maximum dosage is not recommended to exceed 2mg.

The weight loss version of semaglutide includes multiple specifications of 0.25mg, 0.5mg, 1mg, 1.7mg and 2.4mg. It is also taken once a week, but it is generally recommended to start with a dose of 0.25mg, and gradually increase the dose after 4 weeks until it reaches a maintenance dose of 2.4mg per week. Therefore, in terms of the maximum dosage, the weight loss version of semaglutide is greater than the glucose-lowering version.

From the perspective of drug packaging, lowering blood sugar is a process that requires long-term regular medication. Therefore, the glucose-lowering version of semaglutide is packaged in a form where each vial can be used 4 times (one month). For example, patients who choose a 2mg dose of glucose-lowering can use the 8mg specification and inject it with a pen every week, and one vial per month is enough. The weight-loss version of semaglutide uses a single-dose packaging form for single use, and each vial is used once. This is also conducive to more convenient adjustment of medication dosage to a certain extent, and also reduces the problem of drug waste caused by drug intolerance during the weight-loss process.

In terms of weight loss and blood sugar lowering effects, the blood sugar lowering version of semaglutide can effectively reduce patients' glycated hemoglobin levels and body weight. Clinical research data show that a 1mg dose of semaglutide injected once a week not only achieved effective blood sugar control within 30 weeks, but also reduced the average weight of users by about 4.5kg.

For obese patients who do not have diabetes, the weight loss version of semaglutide has a stronger weight loss effect. In a study on the use of semaglutide for weight loss in adults with no history of diabetes, more than 50% of the people had obesity problems and the weekly dosage was 2.4 mg. After 68 weeks of using the drug, the average weight of these subjects decreased by 15%, equivalent to an average weight loss of 15.3 kg. This weight loss effect can be said to be very significant. At the same time, 2.4 mg of semaglutide also improved the metabolic health of obese patients, including blood pressure and cholesterol levels.

From the perspective of medication costs, although the weight loss version of semaglutide has just been approved and its domestic selling price has not yet been announced, judging from the situation abroad, the weight loss version of semaglutide is generally more expensive than the glucose-lowering version. In addition, the glucose-lowering version of semaglutide has now entered the medical insurance catalogue through medical insurance negotiations, while the weight loss version cannot enjoy the medical insurance payment benefits. If compared in this way, the difference in medication costs between the weight loss version and the glucose-lowering version of semaglutide may be even greater.

Seeing this, some of my friends may start to think, since they are all semaglutide, can I use the economical version?

Semaglutide for weight loss and semaglutide for glucose reduction

Are they interchangeable?

In principle, although both are semaglutide, the weight loss version and the glucose-lowering version are not interchangeable, because the two are approved for different indications, and from the above introduction, I believe everyone can understand that the two versions of semaglutide have certain differences in dosage and method of use. Another problem that may arise is that the glucose-lowering version of semaglutide is abused for weight loss, which will also occupy medical resources and cause an imbalance in drug supply.

If you are currently using another weight loss drug, after professional evaluation and confirmation, switching to the weight loss version of semaglutide may have a better improvement effect. This product interchange may be safe, but using a drug with diabetes treatment effects to replace a weight loss version of the drug is still not recommended and advisable.

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Finally, I would like to emphasize that whether it is for lowering blood sugar or losing weight, when using semaglutide, please use the drug on the basis of good lifestyle intervention. Moreover, only by developing good living and eating habits can you better maintain the weight loss results. Please remember that healthy weight loss requires "work will lead to success", and don't pursue "medicine will reduce fat".

Author: Li Jin, deputy director and pharmacist, deputy leader of the Youth Studies Group of the Medical Committee of the China Science Writers Association

Review丨Liu Guiyang, Chief Pharmacist, Fourth Medical Center, PLA General Hospital