Semaglutide

Semaglutide is a synthetic peptide medicine that belongs to the class of GLP-1 receptor agonists. It was developed by Novo Nordisk and has been on the market since 2017. The molecule mimics the natural gut hormone GLP-1 (glucagon-like peptide-1), but has been modified so that it stays in the body much longer (half-life of around a week, compared with a few minutes for natural GLP-1).

By injecting semaglutide once a week or taking it orally every day, GLP-1 activation remains continuously active. That produces a steady effect on appetite, gastric emptying and blood sugar regulation. This pharmacological trick has made semaglutide one of the most influential medicines of the past decade.

Semaglutide is currently available in the Netherlands under three different brands, all from Novo Nordisk. Each version has its own indication, dose and dosage form. You can read more about the individual brands on our pages about Ozempic, Wegovy and Rybelsus.

The STEP trial series (Wegovy 2.4 mg, published in The New England Journal of Medicine 2021) showed an average weight loss of 15% over 68 weeks in obesity patients without diabetes. STEP-1 (n=1,961) was the pivotal study; STEP-2, STEP-3 and STEP-4 confirmed the effect in different subgroups.

The SUSTAIN trial series (Ozempic 0.5-1 mg) showed an HbA1c reduction of 1.2-1.8% in type 2 diabetes and weight loss of 4-6 kg. For the higher dose (2 mg), SUSTAIN FORTE showed more weight loss (6-7 kg).

The SELECT trial (Ozempic 2.4 mg in cardiac patients without diabetes, NEJM 2023) was the first evidence that semaglutide lowers the risk of cardiovascular disease: a 20% reduction in major adverse cardiac events (MACE). This is now taken into account in the reimbursement of Wegovy for specific patient groups.