五点讲清！爆火的司美格鲁肽和替尔泊肽到底有什么区别？

Core Viewpoint - Semaglutide and Tirzepatide are two commonly used GLP-1 receptor agonists for the treatment of type 2 diabetes and obesity, each with distinct structural and functional differences [2][10]. Mechanism of Action - Semaglutide primarily stimulates insulin secretion from pancreatic beta cells, enhances glucose metabolism, and suppresses glucagon secretion, leading to reduced fasting and postprandial blood glucose levels [3]. - In contrast, Tirzepatide acts as a dual agonist for GLP-1 and GIP, activating GLP-1 receptors while mimicking natural GIP, with a weaker ability to drive GLP-1 receptor internalization compared to Semaglutide [5]. Clinical Efficacy - Clinical studies show that Semaglutide leads to significant weight loss; for instance, in the STEP 1 trial, patients lost an average of 14.9% of their body weight after 68 weeks on a 2.4 mg dose [6]. - Tirzepatide demonstrated even greater weight loss in the SURMOUNT-1 and SURMOUNT-2 phase III trials, with the highest dose group (15 mg) achieving an average weight loss of 20.9%, approximately 22 kg [6]. Side Effects - Both medications can cause similar gastrointestinal side effects, including nausea, diarrhea, vomiting, constipation, abdominal pain, bloating, and indigestion, typically mild to moderate and occurring early in treatment [7]. - However, Tirzepatide may reduce these side effects due to its action on GIP receptors, leading to fewer reported side effects and enhanced satiety [9]. Approved Indications - Semaglutide is approved for the treatment of type 2 diabetes and obesity, including use in adolescents aged 12 and older [10]. - Tirzepatide has been approved in China for weight management in patients with a BMI ≥ 28 kg/m² or those with a BMI between 24-28 kg/m² with at least one comorbidity [10][11]. Administration Method - Both Semaglutide and Tirzepatide are administered via subcutaneous injection once a week, with Semaglutide also available in an oral tablet form (Rybelsus) for patients who prefer not to inject [12]. Conclusion - In summary, Semaglutide and Tirzepatide exhibit unique characteristics in terms of weight loss efficacy, mechanisms of action, side effects, and approved indications, necessitating patient-specific treatment decisions based on health status and medical advice [14].