Drug in weight loss injection Wegovy may soon come in pill form

What if treating obesity could be as simple as taking an effective pill?

It’s a notion that has long brought hope to many of the more than 40% of Americans who are considered overweight—and fueled criticism from those who advocate for greater weight acceptance. Soon the pill could be a reality.

High-dose oral versions of drugs in the weight loss drug Wegovy may work as well as the popular injections when it comes to shedding pounds and improving health, according to the final results of two studies released Sunday night. The potent tablets also appear to work for people with diabetes, who notoriously struggle to lose weight.

Drugmaker Novo Nordisk plans to ask the US Food and Drug Administration to approve the pills later this year.

“If you ask people a random question, ‘Would you rather take a pill or an injection?’ People overwhelmingly prefer a pill,” said Dr. Daniel Bessesen, chief of endocrinology at Denver Health, who treats patients with obesity but was not involved in the new research.

It is assumed, said Bessesen, that both ways of taking the medicines are equally effective, accessible and affordable. “These are the most important factors for people,” he said.

There have been other weight loss pills on the market, but none that achieve the significant reductions seen with injectable drugs like Wegovy. People with obesity will be “thrilled” to have an oral alternative that is just as effective, said Dr. Katherine Saunders, clinical professor of medicine at Weill Cornell Health and co-founder of Intellihealth, a weight loss center.

Novo Nordisk already sells Rybelsus, which is approved to treat diabetes and is an oral version of semaglutide, the same medicine used in diabetes medicine Ozempic and Wegovy. It comes in doses of up to 14 milligrams.

But the results of two gold-standard trials released at the American Diabetes Association’s annual meeting looked at how doses of oral semaglutide as high as 25 milligrams and 50 milligrams worked to reduce weight and improve blood sugar and other health markers.

How much weight loss?

A 16-month study of about 1,600 people who were overweight or obese and already being treated for type 2 diabetes found that the high-dose daily pills lowered blood sugar significantly better than the standard dose of Rybelsus. From a base weight of 212 pounds, the higher doses also resulted in weight loss of between 15 and 20 pounds, compared to about 10 pounds on the lower dose.

Another 16-month study of more than 660 adults who were obese or overweight with at least one related disease — but not diabetes — found that the 50-milligram-daily pill helped people lose an average of about 15% of their body weight, or about . 35 pounds, against about 6 pounds with a dummy pill, or placebo.

That’s “particularly consistent” with the weight loss spurred by weekly shots of the highest dose of Wegovy, the study authors said.

“All of these medications work by teaching the hormonal axis between the brain and the gut — the way your brain tells the digestive system, ‘Look, you’ve had enough’ — those are the hormones that these medications affect. They also affect your blood sugar levels,” explained CBS News medical contributor Dr. Céline Gounder on “CBS Mornings.”

But there were side effects. About 80% of participants who received any dose of oral semaglutide experienced things like mild to moderate intestinal problems, such as nausea, constipation, and diarrhea.

“There are some downsides here. From people I know who have been on these medications, they describe it as feeling sick all the time, like when you’ve overeaten,” said Gounder, who is a senior fellow and public health editor at KFF Health news.. “…So you lose weight, but you don’t necessarily feel good when you do.”

In the 50-milligram obesity trial, there was evidence of a higher incidence of benign tumors in people taking the drug compared to placebo. In addition, around 13% of those taking the drug had “changed skin sensation” such as tingling or extra sensitivity.

Medical experts predict the pills will become popular, especially among people who want to lose weight but are afraid of needles. In addition, tablets will be more portable than injection pens, and they will not need to be kept in the refrigerator.

But the pills aren’t necessarily a better option for the hundreds of thousands of people who already take injectable versions like Ozempic or Wegovy, said Dr. Fatima Cody Stanford, an obesity medicine expert at Massachusetts General Hospital.

“I don’t find significant hesitation about getting an injection,” she said. “Many people like the ease of taking a medicine once a week.”

In addition, she said, some patients may actually prefer shots to the new pills, which must be taken 30 minutes before eating or drinking in the morning.

“Part of my routine”

Paul Morer, 56, who works for a hospital in New Jersey, lost 85 pounds with Wegovy and hopes to lose 30 more. He said he would probably stick to the weekly injections, even if pills were available.

“I do it on Saturday mornings. It’s part of my routine,” he said. “I don’t even feel the needle. It’s a non-issue.”

Some critics also worry that a pill would also put pressure on people who are overweight to use it, fueling social stigma against people who can’t — or won’t — lose weight, said Tigress Osborn, head of the National Association . Advance Fat Acceptance.

“There’s no escaping the narrative that your body is wrong and it should change,” Osborn said.

Novo Nordisk is nevertheless betting on the popularity of a higher-dose pill to treat both diabetes and obesity. Rybelsus sales reached around $1.63 billion last year, more than double the 2021 figure.

Other companies are working on oral versions of drugs that work as well as Eli Lilly and Co.’s Mounjaro — an injectable diabetes drug expected to be approved for weight loss soon. Lilly researchers reported promising mid-test results of an oral pill called orforglipron to treat patients who are overweight or obese with and without diabetes.

Pfizer has also released results on the center of dangulgipron, an oral diabetes drug taken twice daily with food.

Novo Nordisk officials said it is too early to say what the price of the company’s high-dose oral pills will be or how the company plans to guarantee sufficient production capacity to meet demand. Despite growing popularity, injectable doses of Wegovy will be in short supply until at least September, company officials said.