Switching From Semaglutide To Tirzepatide

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Semaglutide and tirzepatide are two prominent weight-loss medications that belong to the glucagon-like peptide-1 (GLP-1) receptor agonist class. Semaglutide is the active ingredient in Ozempic and Wegovy, while tirzepatide is the active ingredient in Mounjaro and Zepbound. Ozempic and Mounjaro were initially approved to manage type 2 diabetes and later were discovered to be an effective obesity treatment, leading to the creation of Zepbound and Wegovy for weight loss.

Understanding the nuances between semaglutide and tirzepatide in terms of their efficacy, safety, and considerations for switching is essential for individuals looking to achieve sustainable weight loss goals.

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What is Semaglutide?

Semaglutide, developed by Novo Nordisk, has gained recognition for its potent effects on weight reduction alongside its primary role in managing type 2 diabetes (1,2). Available in injectable and oral forms, Semaglutide works by mimicking the effects of GLP-1, a hormone that helps control blood sugar levels and promotes satiety, thereby aiding weight loss (1,2). Furthermore, studies have shown that semaglutide significantly decreases the occurrence of cardiovascular events including heart attack and stroke (1-3).

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What is Tirzepatide?

Tirzepatide, a newer entrant developed by Eli Lilly and Company, combines GLP-1 receptor agonism with dual GIP (glucose-dependent insulinotropic polypeptide) receptor agonism (4,5). This dual action enhances its ability to lower blood sugar levels and induce weight loss. In fact studies have demonstrated superior hemoglobin A1c reduction and weight loss compared to semaglutide (6,7). Tirzepatide is administered as a once-weekly injection, making it convenient for patients.

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What to Consider Before Switching From Semaglutide to Tirzepatide

Switching medications should always be approached with careful consideration, taking into account various factors such as efficacy, safety profile, patient preferences, and healthcare provider recommendations. Here are key considerations when contemplating a switch from semaglutide to tirzepatide:

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Benefits of Switching From Semaglutide to Tirzepatide

1. Improved Glycemic Control: A major study indicated that tirzepatide offers better hemoglobin A1c reduction (a marker for blood sugar levels) compared to semaglutide. (6) The study evaluated over 1,800 adults with diabetes with an average A1c of 8.3% (normal is < 5.7%). Those on tirzepatide lowered their A1c by 2-2.3 percentage points (depending on injection dose) compared to those on semaglutide who achieved a reduction of 1.86 percentage points (with 1 mg weekly injections). Based on this study, tirzepatide offered more effective blood sugar management and was superior to semaglutide in managing type 2 diabetes. 

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2. Enhanced Weight Loss: A recent study examined thousands of adults across the US with overweight or obesity who were on either tirzepatide or semaglutide. The study found that tirzepatide has superior weight loss outcomes compared to semaglutide. The study revealed that individuals using semaglutide experienced weight loss averaging 3.6% of their body weight after 3 months, 5.8% after 6 months, and 8.3% after 12 months. In contrast, those using Tirzepatide achieved higher monthly weight loss percentages: approximately 5.9% after 3 months, 10.1% after 6 months, and 15.3% after 12 months, surpassing the weight loss observed with semaglutide. 

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Furthermore, this same study found that most individuals using either tirzepatide or semaglutide achieved a weight loss of at least 5% of their initial body weight after one year of treatment. However, 82% of those on tirzepatide reached this significant clinical milestone, compared to only 67% of those on semaglutide. This pattern prevailed for each major milestone. 62% (tirzepatide) vs 37% (semaglutide) achieved 10% or greater weight loss and 42% (tirzepatide) vs 18%  (semaglutide) achieved 15% or greater weight loss within a year. 

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3. Convenience of Dosage: Both tirzepatide's and semaglutide offer once-weekly injection dosing regimen which may be a convenient option for patients not looking to take a daily medication. Semaglutide does come in an oral form as well (Rybelsus), which may be the better option for those looking to avoid injections.

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Risks of Switching From Semaglutide to Tirzepatide

1. Adverse Effects: Both medications may have commonly reported side effects which are generally gastrointestinal disturbances (nausea, vomiting, diarrhea, stomach upset) and injection-site reactions (1,2,4,5). Patients switching medications should be monitored for these potential adverse effects, and their dose escalation plan should be tailored accordingly with the help of a licensed professional.
2. Individual Response Variation: Response to GLP-1 receptor agonists can vary among individuals. Switching medications could lead to different tolerability or efficacy outcomes.

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How To Switch From Semaglutide to Tirzepatide

Switching medications should ideally be discussed and managed under the guidance of a healthcare provider experienced in obesity management. The process may involve:

1. Consultation with Healthcare Provider: Discussing reasons for switching, reviewing medical history, and assessing suitability for tirzepatide.
2. Adjusting Dosage: Transitioning from semaglutide to tirzepatide may involve titrating doses to ensure seamless continuity in weight loss program and prevent severe side effects. 
3. Monitoring: Regular monitoring of blood glucose levels, hemoglobin A1c labs, weight loss, and any potential side effects during the transition period are critical.

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Get Expert Guidance On GLP-1 Medications From Mochi Health

At Mochi Health, our team of healthcare providers specializes in obesity management and GLP-1 receptor agonist therapies. We provide personalized guidance and support for patients considering or undergoing a switch from semaglutide to tirzepatide. Our goal is to empower individuals with the knowledge and resources needed to make informed decisions about their health.

In conclusion, while both semaglutide and tirzepatide offer significant benefits in managing type 2 diabetes and weight loss, the decision to switch between these medications should be based on individual patient needs and guided by healthcare provider expertise. For more information and expert advice on GLP-1 medications, see if you’re eligible to join Mochi Health today.

By staying informed and working closely with healthcare providers, patients can navigate the complexities of diabetes management effectively, ensuring optimal outcomes and improved quality of life.

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Sources

1. Wilding, J. P. H., Batterham, R. L., Calanna, S., Davies, M., Van Gaal, L. F., Lingvay, I., McGowan, B. M., Rosenstock, J., Tran, M. T. D., Wadden, T. A., Wharton, S., Yokote, K., Zeuthen, N., Kushner, R. F., & STEP 1 Study Group (2021). Once-Weekly Semaglutide in Adults with Overweight or Obesity. The New England journal of medicine, 384(11), 989–1002. https://www.nejm.org/doi/full/10.1056/NEJMoa2032183
2. Food and Drug Administration.  “Highlights of Prescribing Information - OZEMPIC (semaglutide) Injection”. Access Data FDA, Food and Drug Administration, revised 2020. https://www.accessdata.fda.gov/drugsatfda_docs/label/2020/209637s003lbl.pdf
3. Aroda VR, Ahmann A, Cariou B, Chow F, Davies MJ, Jódar E, Mehta R, Woo V, Lingvay I. Comparative efficacy, safety, and cardiovascular outcomes with once-weekly subcutaneous semaglutide in the treatment of type 2 diabetes: Insights from the SUSTAIN 1-7 trials. Diabetes Metab. 2019 Oct;45(5):409-418. doi: 10.1016/j.diabet.2018.12.001. https://pubmed.ncbi.nlm.nih.gov/30615985/
4. Jastreboff AM, Aronne LJ, Ahmad NN, Wharton S, Connery L, Alves B, Kiyosue A, Zhang S, Liu B, Bunck MC, Stefanski A; SURMOUNT-1 Investigators. Tirzepatide Once Weekly for the Treatment of Obesity. N Engl J Med. 2022 Jul 21;387(3):205-216. https://www.nejm.org/doi/full/10.1056/NEJMoa2206038
5. Food and Drug Administration. “Highlights of Prescribing Information - ZEPBOUND (Tirzepatide) Injection”. Access Data FDA, Food and Drug Administration, revised 2023. www.accessdata.fda.gov/drugsatfda_docs/label/2023/217806s000lbl.pdf
6. Frías JP, Davies MJ, Rosenstock J, Pérez Manghi FC, Fernández Landó L, Bergman BK, Liu B, Cui X, Brown K; SURPASS-2 Investigators. Tirzepatide versus Semaglutide Once Weekly in Patients with Type 2 Diabetes. N Engl J Med. 2021 Aug 5;385(6):503-515. doi: 10.1056/NEJMoa2107519. https://www.nejm.org/doi/full/10.1056/NEJMoa2107519‍
7. Rodriguez PJ, Goodwin Cartwright BM, Gratzl S, et al. Semaglutide vs Tirzepatide for Weight Loss in Adults With Overweight or Obesity. JAMA Intern Med. Published online July 08, 2024. doi:10.1001/jamainternmed.2024.2525. https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2821080?&utm_source=BulletinHealthCare&utm_medium=email&utm_term=070924&utm_content=MEMBER&utm_campaign=article_alert-morning_rounds_daily&utm_uid=15689092&utm_effort=MRNRD0