Patient Education - weight loss
What's the Difference Between the newly available GLP-1 medications?
Review by Glenn Gaunt, MD
Mounjaro (terzepatide), Zepbound (terzepatide), Ozempic (semaglutide), and Wegovy (semaglutide) are injectable medications that help control blood sugar levels. All four medications have quickly become popular, thanks to their weight loss benefits. While terzepatide and semaglutide offer similar benefits, there are key differences that set both medications apart.
I recently spent a couple weeks getting a patient approved with their insurance carrier for Mounjaro. We got her approved. It is interesting to note that the obvious foot dragging delay tactics of this particular insurance carrier were counterproductive. Consider this:
Well-designed peer reviewed studies show that people being treated with terzepatide (along with eating a healthy diet and regular physical activity) helps protect against cardiovascular disease – heart problems. It also helps lower blood pressure, which reduces the risk of cardiovascular events like heart attack and stroke.
Finally, the patient and I made the decision together to seek a Prior Authorization for semaglutide. Guess, what? It was approved the same day. Which naturally begs the question: “what’s the difference?”
What Do the Medications Do?
They all belong to a class of drugs called glucagon-like peptide-1 (GLP-1) receptor agonists which work by mimicking the effects of two naturally occurring hormones in your body: glucose-dependent insulinotropic polypeptide (GIP) and glucagon-like peptide-1 (GLP-1) receptor agonists. GLP-1 and GIP are hormones that your stomach releases after eating food. Both hormones work together to regulate your blood sugar levels.
How Terzepatide Works
Terzepatide is an FDA-approved, once-a-week medication that you inject under your skin. This medication also controls blood sugar levels in adults with diabetes. Healthcare providers recommend this alongside diet and exercise plans. Mounjaro and Zepbound are the first and only medications in its class that activates two gut hormones that regulate blood sugar in people: GLP-1 and GIP.
Currently, Mounjaro is only approved for use in treating type 2 diabetes. However, the FDA has approved Zepbound for weight loss. In one study, two-thirds of participants reduced their body weight by 20% or more.
How Semaglutide Works
Semaglutide is also an FDA-approved medication for adults with diabetes. This drug helps control blood sugar when combined with diet and exercise. Healthcare providers typically prescribe this to people with type 2 diabetes and heart disease to reduce the risk of cardiovascular events, like stroke or heart attack.
This medication is a GLP-1 agonist, which activates the body's GLP-1 receptors, prompts the pancreas to produce insulin after eating, and helps control blood sugar levels in people with diabetes. It also signals to the brain that you've eaten, which can make you feel full early and help promote better weight control.
Similarities:
Semaglutide and Terzepatide are prescription medications that you inject subcutaneously (under the skin) once a week. They are similar in the following ways:
Control blood sugar levels in people effectively
Help promote weight loss in people
Reduce the risk of major cardiovascular events, such as heart attack and stroke
Have similar side effects, including nausea, vomiting, stomach pain, diarrhea, constipation, or indigestion
Differences:
Despite the similarities between them, the two medications have some key differences.
How They Work Biologically
Terzepatide is a dual-acting GIP (glucose-dependent insulinotropic polypeptide) and GLP-1 (glucagon-like peptide-1) receptor agonist. It is the first and only drug of its kind, mimicking the effects of both hormones. Semaglutide, on the other hand, is a single-agent GLP-1 receptor agonist.
Effectiveness
In clinical trials, 80% of people who took terzepatide lost at least 5% of their body weight, and 36% lost more than 15%. Of those who took semaglutide, 54% of participants lost at least 5% of their body weight, while 8% lost more than 15%. Terzepatide resulted in more significant reductions in A1C, a measure of long-term blood sugar levels.
Dose and Administration
You administer these medications once a week through pen injectors that come pre-filled with the medication.
Semaglutide is available in 0.25 mg, 0.5 mg, 1.0 mg, and 2.0 mg doses. Each pen injector contains four doses, which is equivalent to a month's worth of medication.
Terzepatide injector pens are single use, meaning you will use a new pen for each injected dose. The pens contain either 2.5 mg, 5 mg, 7.5 mg, 10 mg, 12.5 mg, or 15 mg of the drug, depending on your prescription and how much medication your provider thinks you need. Four pens are the equivalent of a month’s worth of injection.
Cost
The cost of these medications vary, depending on your dosage, insurance coverage, and whether you qualify for the manufacturer's savings program. Most insurance plans provide at least partial coverage for Terzepatide and Semaglutide.
Which Is Better?
Whether Terzepatide or Semaglutide is better depends on your needs and treatment goals. While Terzepatide is more effective for lowering A1C (your average blood sugar levels over three months) and weight loss, Semaglutide is FDA-approved to prevent heart complications in people with type 2 diabetes and cardiovascular disease.
The best way to decide which medication is right for you is to talk to your healthcare provider. They can help you to weigh the pros and cons of each and choose the option that is best for you and your individual health needs.
Can You Switch From One to the Other?
It is possible to switch from Semaglutide to Terzepatide or vice versa. You may want to change medications if you are not seeing the desired results or are having difficulty with the medication's side effects. Pharmacy data shows that up to 25% of people switch from their initial blood sugar medication to another after the first year of treatment.
Switching from one medication to another is a decision you should make in close consultation with your healthcare provider. These medications, though similar in some respects, work slightly differently and have different dosages. That said, making the decision to switch medicines requires careful consideration. If changing medications is the right choice, your healthcare provider will develop a safe and effective transition plan for you.
A Quick Review
Terzepatide and Semaglutide are injectable medications with FDA approval that help lower blood sugar in people with type 2 diabetes. Semaglutide is also approved to lower the risk of heart complications like heart attack and stroke among people with type 2 diabetes and heart disease. However, Terzepatide is better for weight loss and long-term blood sugar control.
Talk to your healthcare provider about Semaglutide or Terzepatide to determine whether these medications are a good option. They can help you understand which medication is right for you and create a treatment plan that meets your body's needs.