Semaglutide (oral)

What the number means

Estimated mean change in body weight at week 64 was −14% on oral semaglutide 25 mg against −2% on placebo (p<0.001), in 307 adults with overweight or obesity and without diabetes, randomised 205 to 25 mg and 102 to placebo. Wharton S, Lingvay I, Bogdanski P, et al. N Engl J Med 2025;393(11):1077-1087.

Trial averages are not a forecast for any individual. Response varies widely, the trial population was screened and supported in ways a subscription is not, and the figure describes people who stayed on the medication for the full period.

Worth knowing

• ◆The same molecule as the Wegovy injection, and the result is close enough to be treated as equivalent: −14% here against −14.9% in STEP 1. The argument for the pill is the route, not a better outcome.
• ◆It is a peptide protected by an absorption enhancer rather than a small molecule, which is why it carries timing rules orforglipron does not. Novo instructs taking it on waking, on an empty stomach, with no more than 4 oz of water, then waiting 30 minutes before eating, drinking or taking any other oral medicine.
• ◆That 30-minute window arrives every single day, where the injection is a weekly event. Anyone who takes a morning thyroid tablet, or who cannot reliably delay coffee, should weigh that before choosing the pill on convenience grounds.
• ◆Titration runs from 1.5 mg, rising every 30 days as tolerated to a 25 mg maximum — the dose OASIS 4 studied.
• ◆Novo publishes self-pay pricing of $149 a month for the 1.5 mg and 4 mg doses. It does not publish a self-pay price for 25 mg on that page, so the advertised figure covers titration rather than maintenance. List price is $1,349.02 a package.