10/01/2023
Clinical studies on Rybelsus
FDA approval of the Rybelsus comes from positive outcomes of a global clinical programme called PIONEER, which included ten Phase Ill clinical studies, enrolling 9543 patients with type 2 diabetes
Rybelsus was compared with other blood sugar-lowering agents including sitagliptin, empagliflozin and liraglutide, more effective in reducing blood sugar levels than other agents in injection form. Rybelsus was well tolerated by the patients, reducing the body weight of the patients by up to 4.4kg.
"The oral formulation of semaglutide received marketing authorisation in the European Union for type 2 diabetes treatment in January 2020."
PIONEER 2, a head-to-head clinical study of oral semaglutide, was conducted against Jardiance® (empagliflozin). The patients administered with oral semaglutide demonstrated 44% more blood glucose decline when compared to patients receiving Jardiance at week 26
PIONEER 3, a head-to-head clinical study of oral semaglutide with Januvia (sitagliptin), showed 63% greater reduction of blood glucose level in patients taking 14mg semaglutide than those administered with 100m Januvia at week 26.
PIONEER 4, a head-to-head clinical study of 14mg oral semaglutide with 1.8mg liraglutide, also demonstrated the non-inferiority of the oral drug to the subcutaneous drug
PIONEER 6 clinical study was designed to study the cardiovascular safety in type 2 diabetes patients at cardiovascular disease risk. The study showed 21% lesser MACE events in patients receiving oral semaglutide than those on placebo.
The clinical programme also includes the study of Rybeisus in combination with other diabetes drugs such as Metformin.
Common adverse events observed in patients during the clinical studies were abdomen pain, nausea, diarrhea, reduced appetite, vomiting and constipation.
Important Safety Information for RYBELSUS® (semaglutide) tablets 7 mg or 14 mg
WARNING: RISK OF THYROID C-CELL TUMORS
In rodents, semaglutide causes dose-dependent and treatment-duration dependent thyroid C-cell tumors at clinically relevant exposures. It is unknown whether RYBELSUS® causes thyroid C-cell tumors, including medullary thyroid carcinoma (MTC), in humans as human relevance of semaglutide-induced rodent thyroid C-cell tumors has not been determined RYBELSUS® is contraindicated in patients with a personal or family history of MTC and in patients with Multiple Endocrine Neoplasia syndrome type 2 (MEN 2). Counsel patients regarding the potential risk for MTC with the use of RYBELSUS® and inform them of symptoms of thyroid tumors (e.g. a mass in the neck, dysphagia, dyspnea, persistent hoarseness). Routine
monitoring of serum calcitonin or using thyroid ultrasound is of uncertain value for early detection of MTC in patients treated with RYBELSUS®
Indication and Usage
RYBELSUS® (semaglutide) tablets 7 mg or 14 mg is indicated as an adjunct to diet and exercise to improve glycemic control in adults with type 2 diabetes.
Limitations of Use
RYBELSUS® has not been studied in patients with a history of pancreatitis. Consider other antidiabetic therapies in patients with a history of pancreatitis
RYBELSUS® is not indicated for use in patients with type 1 diabetes
Important Safety Information Contraindications
RYBELSUS® is contraindicated in patients with a personal or family history of medullary thyroid carcinoma (MITC) or in patients with Multiple Endocrine Neoplasia syndrome type 2 (MEN 2), and in patients with a prior serious hypersensitivity reaction to semaglutide or to any of the excipients in RYBELSUS®. Serious hypersensitivity reactions including anaphylaxis and angioedema have been reported with RYBELSUS®
Warnings and Precautions
Risk of Thyroid C-Cell Tumors: Patients should be further evaluated if serum calcitonin is measured and found to be elevated or thyroid nodules are noted on physical examination or neck imaging
Pancreatitis: Has been reported in clinical trials. Observe patients carefully for signs and symptoms of pancreatitis (including persistent severe abdominal pain, sometimes radiating to the back and which may or may not be accompanied by vomiting). If pancreatitis is suspected, discontinue RYBELSUS® and initiate appropriate management; if confirmed, do not restart
RYBELSUS®
Diabetic Retinopathy Complications: In a pooled analysis of glycemic control trials with
RYBELSUS®, patients reported diabetic retinopathy related adverse reactions during the trial (4.2% with RYBELSUS® and 3.8% with comparator). In a 2-year trial with semaglutide injection involving patients with type 2 diabetes and high cardiovascular risk, more events of diabetic retinopathy complications occurred in patients treated with semaglutide injection (3.0%) compared to placebo (1.8%). The absolute risk increase for diabetic retinopathy complications was larger among patients with a history of diabetic retinopathy at baseline than among patients without a known history of diabetic retinopathy.
Rapid improvement in glucose control has been associated with a temporary worsening of diabetic retinopathy. Patients with a history of diabetic retinopathy should be monitored for progression of diabetic retinopathy
Hypoglycemia: Patients receiving RYBELSUS® in combination with an insulin secretagogue (e.g., sulfonylurea) or insulin may have an increased risk of hypoglycemia, including severe hypoglycemia. Inform patients using these concomitant medications of the risk of hypoglycemia and educate them on the signs and symptoms of hypoglycemia
Acute Kidney Injury: There have been postmarketing reports of acute kidney injury and worsening of chronic renal failure, which may sometimes require hemodialysis, in patients treated with GLP-1 receptor agonists, including semaglutide. Some of these events have been reported in patients without known underlying renal disease. A majority of the reported events occurred in patients who had experienced nausea, vomiting, diarrhea, or dehydration. Monitor renal function when initiating or escalating doses of RYBELSUS® in patients reporting severe adverse gastrointestinal reactions
Hypersensitivity: Serious hypersensitivity reactions (e.g., anaphylaxis, angioedema) have been reported in patients treated with RYBELSUS®. If hypersensitivity reactions occur, discontinue use of RYBELSUS®, treat promptly per standard of care, and monitor until signs and symptoms resolve. Use caution in a patient with a history of angioedema or anaphylaxis with another GLP-1 receptor agonist
Acute Gallbladder Disease: Acute events of gallbladder disease such as cholelithiasis or cholecystitis have been reported in GLP-1 receptor agonist trials and postmarketing. In placebo-controlled trials, cholelithiasis was reported in 1% of patients treated with RYBELSUS® 7 mg. Cholelithiasis was not reported in RYBELSUS® 14 mg or placebo-treated patients. If cholelithiasis is suspected, galibladder studies and appropriate clinical follow-up are indicated
Adverse Reactions
Most common adverse reactions (incidence 25%) are nausea, abdominal pain, diarrhea, decreased appetite, vomiting and constipation
Drug Interactions
RYBELSUS® stimulates insulin release in the presence of elevated blood glucose concentrations. When initiating RYBELSUS®, consider reducing the dose of concomitantly administered insulin secretagogue (such as sulfonylureas) or insulin to reduce the risk of hypoglycemia
RYBELSUS® delays gastric emptying and has the potential to impact the absorption of other oral medications. Closely follow RYBELSUS® administration instructions when coadministering with other oral medications and consider increased monitoring for medications with a narrow therapeutic index, such as levothyroxine
Use in Specific Populations
Pregnancy: Available data with RYBELSUS® are not sufficient to determine a drug-associated risk for major birth defects, miscarriage, or other adverse maternal or fetal outcomes. Based on animal reproduction studies, there may be risks to the fetus from exposure to RYBELSUS®.
Use only if the potential benefit justifies the potential risk to the fetus
Lactation: There are no data on the presence of semaglutide in human milk, the effects on the breastfed infant, or the effects on milk production. Because of the unknown potential for serious adverse reactions in the breastfed infant due to the possible accumulation of salcaprozate sodium (SNAC), an absorption enhancer in RYBELSUS®, from breastfeeding and because there are alternative formulations of semaglutide that can be used during lactation, advise patients that breastfeeding is not recommended during treatment with RYBELSUS®
Discontinue RYBELSUS® in women at least 2 months before a planned pregnancy due to the long washout period for semaglutide
Pediatric Use: Safety and effectiveness of RYBELSUS® have not been established in pediatric patients
