司美格鲁肽口服、针剂该怎么选？效果、安全性差异？

Core Viewpoint - The article provides a comprehensive comparison of different formulations of semaglutide, focusing on their efficacy, safety, mechanisms of action, administration methods, and storage requirements, highlighting the potential for weight loss and blood sugar control in patients. Efficacy and Safety - Both injection and oral formulations of semaglutide are effective for weight loss, with the oral formulation showing a weight reduction of 13.6% in the OASIS 4 study compared to 2.2% in the placebo group. If all participants completed the treatment, the weight loss could reach 16.6% for the oral group and 2.7% for the placebo group [3][6] - The PIONEER series of phase III clinical trials demonstrated that oral semaglutide can lower HbA1c levels by up to 1.5%, achieving an 80% target rate [3][6] - Safety profiles for both formulations are similar, with common side effects including nausea, vomiting, and diarrhea, although the injection may carry a higher risk of local reactions at the injection site [11] Mechanism of Action - Semaglutide operates through a glucose-dependent mechanism, improving beta-cell function and insulin resistance while suppressing glucagon secretion [12] - It mimics the GLP-1 hormone to regulate appetite in the brain, reducing hunger and prolonging satiety by slowing gastric emptying [12] - The oral formulation utilizes SNAC technology to enhance peptide absorption and protect it from degradation, increasing bioavailability by approximately 100 times [12] Administration and Convenience - The oral formulation is taken once daily without the need for cold chain storage, making it convenient for patients who fear injections [14] - The injection formulation is administered weekly and requires cold chain storage, suitable for patients who are comfortable with injections [14] Storage and Transportation - The oral formulation can be stored in a dry place at temperatures not exceeding 30°C, facilitating easier storage and transport [15] - The injection formulation requires strict cold chain storage and transport at temperatures between 2-8°C, posing higher storage requirements [15] Dosage and Specifications - The oral formulation comes in various dosages, starting at 3mg daily, with the option to increase to 7mg after 30 days based on individual needs [16] - The injection formulation has multiple specifications, starting at 0.25mg weekly, with gradual increases over a 17-week period to reach a maintenance dose [18]