Semaglutide and Liraglutide: Choosing the Best Weight Loss Medication

Obesity has become an escalating public health crisis in the US, with almost 70% of adults considered overweight or obese. Excess weight puts individuals at higher risk for chronic diseases like type 2 diabetes, heart disease, and certain cancers. While bariatric surgery is an option for some, prescription medications may provide a less invasive way to manage obesity and promote weight loss.

Two of the newest drugs approved for chronic weight management are semaglutide and liraglutide. Both belong to a class of medications called glucagon-like peptide-1 (GLP-1) receptor agonists. However, there are some key differences between these two obesity medications in terms of their approved uses, efficacy for weight loss, dosing, side effects, and cost.

In this article, we will compare and contrast semaglutide and liraglutide to provide a comprehensive overview of how these two weight-loss drugs differ. Understanding the unique attributes of each medication can help inform discussions between patients and healthcare providers regarding obesity treatment options and goals.

1. Approved Uses

Semaglutide and liraglutide have overlapping but distinct approved uses for diabetes management and weight loss. Knowing what each is sanctioned to treat can help determine if it suits you.

Semaglutide

Semaglutide injection is primarily prescribed for the treatment of type 2 diabetes in adults. It is used in conjunction with a balanced diet and exercise program to help control blood sugar levels when other medications have not been effective.

This medication assists the pancreas in releasing the right amount of insulin when blood sugar levels are high. It also slows the emptying of the stomach, potentially reducing appetite and facilitating weight loss. Semaglutide is not intended for the treatment of type 1 diabetes or diabetic ketoacidosis, a serious condition resulting from untreated high blood sugar.

In addition to diabetes management, semaglutide (Wegovy) is also approved for use in obese adults and overweight adults who have other health issues like high blood pressure, diabetes, or high cholesterol.

Furthermore, it is sanctioned for treating obesity in adolescents aged 12 years and older. The medication is combined with a personalized low-calorie, low-fat diet and exercise program to promote weight loss.

The approval of semaglutide signifies its utility in addressing the complications associated with diabetes and obesity, such as:

• Heart disease
• Stroke
• Kidney problems
• Nerve damage
• Eye problems

This medication plays a crucial role in enhancing overall health and decreasing the risk of heart attacks, strokes, and other diabetes-related complications.

Liraglutide

Liraglutide injection is also prescribed for the management of type 2 diabetes in both adults and children aged ten and older. In this context, it aids in controlling blood sugar levels when other medications have not been sufficiently effective.

Liraglutide assists the pancreas in regulating insulin production and slows the emptying of the stomach, which may lead to weight loss. However, it is not meant for the treatment of type 1 diabetes or diabetic ketoacidosis in adults.

In addition to its role in diabetes management, liraglutide (Saxenda) is approved for use in promoting weight loss in certain adults and adolescents who are obese or overweight with weight-related medical problems. It's important to note that Saxenda is not indicated for the treatment of type 2 diabetes, distinguishing it from some other medications like semaglutide.

2. Effectiveness in Weight Loss

Regarding weight loss results, studies show that semaglutide outperforms liraglutide significantly. Understanding the level of weight loss achieved with each can help guide medication selection.

Semaglutide

A landmark study published in the New England Journal of Medicine in March 2021 involved 1,961 obese patients without type 2 diabetes. They were given 2.4mg of once-weekly subcutaneous semaglutide injections or a placebo over 64 weeks.

The results were impressive, with the semaglutide group experiencing an average weight loss of 14.9% from their baseline body weight.

In contrast, the placebo group only had a 2.5% weight loss. These results surpassed the weight loss achieved with other anti-obesity medications, which typically ranged from 4.0% to 10.9% of baseline body weight.

A more recent study published in JAMA Network in January 2022 compared semaglutide and liraglutide in a 68-week trial involving 338 adults with overweight or obesity and no type 2 diabetes. The findings revealed a mean weight reduction of -15.8% in the semaglutide group, indicating its substantial effectiveness in promoting weight loss.

Liraglutide

In a 2015 study published in the New England Journal of Medicine, a 56-week clinical trial was conducted with overweight and obese adults without type 2 diabetes. They were given daily 3.0mg liraglutide injections or a placebo.

The results showed that 63.2% of the liraglutide group lost more than 5% of their baseline body weight, while only 27.1% of the placebo group achieved this level of weight loss. Furthermore, 33.1% of the liraglutide group reduced more than 10% of their body weight.

In the liraglutide group, participants, on average, lost 8.4 kilograms of body weight, with a range of 7.3 kilograms above or below that average. This is in contrast to the placebo group, where participants lost an average of 2.8 kilograms, with a range of 6.5 kilograms above or below that average.

The 2022 study in JAMA Network compared semaglutide and liraglutide for weight loss, highlighting semaglutide's superior performance. Specifically, semaglutide resulted in a weight loss 9.4 percentage points greater than liraglutide.

In the 68-week trial, semaglutide showed a mean weight change of –15.8% compared to liraglutide's –6.4%. The odds of achieving 10%, 15%, and 20% or more weight loss were significantly higher with semaglutide (70.9%, 55.6%, and 38.5%, respectively) compared to liraglutide (25.6%, 12.0%, and 6.0%).

Gastrointestinal adverse events were reported by 84.1% with semaglutide and 82.7% with liraglutide. This suggests that semaglutide outperforms liraglutide in weight loss efficacy and provides a more detailed overview of the study's findings.

3. Dosage Difference

Semaglutide and liraglutide have different recommended dosing schedules. Understanding how each one is administered can help you determine if the frequency may fit your lifestyle and preferences.

Semaglutide

For type 2 diabetes, it is administered subcutaneously once a week, typically starting with a low dose and adjusted based on individual response.

For weight loss in obese or overweight adults, it follows a similar regimen of a once-a-week subcutaneous injection with dose adjustments over time. It's essential to use it regularly even if you start to feel better. The dosage for adults is generally the same for both diabetes control and weight loss purposes.

Liraglutide

Liraglutide also has applications for blood sugar control in type 2 diabetes and weight loss. When used for diabetes control in adults and children ten years and older, it's administered subcutaneously once a day in the stomach, thigh, or upper arm.

The initial dose is low, and your doctor may adjust it after one week. It's essential to continue using it even when you feel well. When used for weight loss in adults and children 12 years and older, it follows the same once-a-day subcutaneous injection regimen in the stomach, thigh, or upper arm.

If weight loss is not achieved after a specific period, your doctor may discontinue the treatment. The dosage for weight loss in adults and children is typically the same.

4. Side Effects

While both medications may cause some side effects, semaglutide has a more favorable safety profile.

One study showed that semaglutide is more tolerated in terms of side effects compared to liraglutide. The lower percentage of participants discontinuing treatment due to side effects in the semaglutide group (3.2%) as opposed to the liraglutide group (12.6%) suggests better tolerability for semaglutide.

However, it's worth noting that both groups experienced gastrointestinal (GI) issues, with over 80% of participants in each reporting constipation, cramping, bloating, and diarrhea. So, while semaglutide may be better tolerated overall, GI-related side effects were common in both groups.

Semaglutide

Common side effects may include:

• Nausea
• Vomiting
• Diarrhea
• Abdominal pain
• Constipation
• Heartburn
• Burping

More severe side effects that require immediate medical attention:

• Ongoing upper stomach pain (with or without vomiting)
• Rash, itching, or swelling of the eyes, face, mouth, tongue, or throat
• Difficulty breathing or swallowing
• Decreased urination or swelling of legs, ankles, or feet
• Vision changes
• Fainting or dizziness
• Rapid heartbeat, anxiety, mood changes, or confusion

Semaglutide may affect mental health, leading to symptoms such as depression or suicidal thoughts. Contact your doctor if you experience these symptoms.

Liraglutide

Common side effects may include:

• Headache
• Constipation
• Heartburn
• Runny nose, sneezing, or cough
• Tiredness
• Difficulty urinating or pain or burning on urination
• Injection site rash or redness

More severe side effects that require immediate medical attention:

• Ongoing upper stomach pain (may spread to the back)
• New or worsening depression
• Thoughts of self-harm or unusual changes in mood or behavior
• Vomiting
• Nausea
• Diarrhea
• Clay-colored stools
• Yellow eyes or skin
• Heart palpitations, dizziness, or fainting
• Swelling of the eyes, face, mouth, tongue, or throat
• Rash, itching, or difficulty breathing or swallowing

If you miss using liraglutide for three or more days, contact your doctor.

8. Cost

Semaglutide is more cost-effective than liraglutide for equivalent weight loss results. Considering the expense of these medications is vital when selecting treatment.

Semaglutide

The cost of Semaglutide, marketed under the brand name Ozempic, has been a significant concern for many patients. In the US, as of February 2023, the monthly out of pocket cost of Ozempic averages around $804 per month.

To provide a more detailed perspective, the cost of a single pre-filled pen of Ozempic, which is administered once per week and typically offers a dosage of 0.5–1 milligram, is approximately $195.

In terms of cost-effectiveness, a study directly compared semaglutide to liraglutide (Saxenda) for weight reduction. This study calculated the total cost of therapy with semaglutide (Ozempic) during the trial, estimated at approximately $22,878.

Notably, the Cost Needed to Treat (CNT) for achieving a 1% reduction in body weight with semaglutide was roughly $1,845. This suggests semaglutide is a cost-effective option,compared to liraglutide, for individuals seeking to reduce their body weight.

Liraglutide

The cost of Liraglutide, available under the brand name Saxenda can be a significant consideration for patients. The cost for Saxenda can vary depending on the pharmacy you visit. On average, the cost for a supply of 15 milliliters of Saxenda subcutaneous solution (18 mg/3 mL) is around $1,430.

In the same study that evaluated semaglutide, liraglutide (Saxenda) resulted in a weight loss of approximately 5.4% during the STEP 1 trial.

The study estimated the total cost of therapy with liraglutide at roughly $17,585. Importantly, when calculating the CNT for a 1% reduction in body weight with liraglutide, it was significantly higher, at approximately $3,256.

This implies that liraglutide, while effective for weight reduction, comes at a higher cost per unit of weight loss than semaglutide.

Final Words

Both semaglutide and liraglutide are effective GLP-1 receptor agonists that can promote weight loss in obese or overweight adults. However, research indicates that semaglutide results in significantly more significant weight reduction than liraglutide.

Semaglutide has a better safety profile with mainly gastrointestinal side effects, while liraglutide can potentially lead to more serious side effects like gallbladder problems. Also, semaglutide is more cost-effective for achieving equivalent weight loss based on the calculated treatment cost.

Semaglutide seems to be the superior option between the two drugs for obese or overweight patients seeking substantial weight loss with minimal side effects. However, consult a doctor to determine which medication is more suitable based on individual health status and treatment goals.

FAQs on Semaglutide and Liraglutide

Why is semaglutide preferred over liraglutide?

Semaglutide is generally preferred over liraglutide for weight loss and blood sugar control in people with obesity and type 2 diabetes because studies directly comparing the two medications have shown that semaglutide leads to significantly more weight loss and better glycemic control.

How do I choose between semaglutide and liraglutide for my diabetes management?

The choice depends on your individual needs, preferences, and your doctor's recommendation. Factors like dosing frequency, potential side effects, and weight management goals may influence your decision.

Can semaglutide and liraglutide be used together?

Combining these medications is not recommended. It's essential to consult with a healthcare professional to determine the most suitable treatment plan for your specific condition.