Review
This Chinese clinical comprehensive evaluation systematically compared five long-acting GLP-1 receptor agonists (dulaglutide, semaglutide, polyethylene glycol loxenatide, tirzepatide, and mazdutide) for the management of type 2 diabetes within China's healthcare context. The researchers constructed a quantitative, six-dimensional scoring framework—covering efficacy, safety, economy, innovation, suitability, and accessibility—with indicator weights derived through a Delphi expert consultation process. Evidence sources included drug labels, systematic literature reviews, and real-world data. Semaglutide scored highest (76.6/100) followed by dulaglutide (72.6), polyethylene glycol loxenatide (64.8), tirzepatide (62.9), and mazdutide (55.1). Semaglutide and dulaglutide were classified as "Strong Recommendations," largely due to superior cardio-renal outcome evidence. Tirzepatide and polyethylene glycol loxenatide received "Conditional Recommendations," while mazdutide was "Not Recommended" owing to insufficient evidence, lack of national reimbursement listing, and high cost. Key limitations include the inherent subjectivity of the Delphi weighting process, the China-specific formulary and reimbursement context limiting global generalizability, and the composite nature of the scoring system potentially obscuring individual domain differences.
Diabetes, metabolic syndrome and obesity : targets and therapy · Feb 2026DOI ↗ Insufficient
This systematic review surveyed ClinicalTrials.gov (from inception through July 2025) to map the landscape of registered clinical trials investigating glucagon-like peptide-1 receptor agonists (GLP-1RAs) as potential treatments for substance use disorders (SUDs). Of 192 records identified, 33 trials met inclusion criteria. The most commonly studied SUD was alcohol use disorder (15 trials), followed by nicotine/tobacco (9), cocaine (4), opioid (4), and methamphetamine (1); no trials targeting cannabis use disorder were identified. Agents under investigation included semaglutide, exenatide, tirzepatide, liraglutide, dulaglutide, and pemvidutide. The review found that trial designs and outcome measures were highly heterogeneous, often blending self-reported measures (e.g., Timeline Follow-Back, craving scales) with objective indices (e.g., urine toxicology). The authors note that most registered trials rely on older-generation GLP-1RAs and that significant gaps exist for methamphetamine and cannabis use disorders. As a registry-based systematic review, it does not report clinical efficacy data from completed trials. The authors conclude that next-generation GLP-1RAs and trials using FDA-recommended endpoints are needed to establish efficacy and safety across the full spectrum of SUDs.
Addictive behaviors reports · Jan 2026DOI ↗ Limited · human
This case report describes an 18-year-old woman with no prior medical history who developed euglycemic ketoacidosis (EKA) in association with self-administered semaglutide purchased online without medical supervision. After initiating the medication ten days prior and self-escalating doses, she presented with three days of nausea, intractable vomiting, and reduced oral intake. Laboratory findings revealed a high-anion gap metabolic acidosis (pH 7.24, bicarbonate 14 mmol/L, anion gap 24 mEq/L), markedly elevated β-hydroxybutyrate (5.9 mmol/L), and normal blood glucose (60 mg/dL), meeting criteria for EKA. She was treated with intravenous fluids, dextrose infusion, and supportive care, with clinical recovery and discharge within 36 hours. The authors propose that reduced oral intake combined with GLP-1 receptor agonist-induced gastrointestinal side effects may have triggered a starvation-like ketogenic state. Key limitations include the single-patient design, inability to verify the authenticity or exact composition of the online-purchased product, and lack of confirmed dosing history. The case raises awareness of EKA as a potential complication of GLP-1 receptor agonist use, particularly in unsupervised, non-diabetic individuals using unregulated sources.
Review
This narrative review examines three incretin-based therapies — liraglutide, semaglutide, and tirzepatide — approved for weight management in non-diabetic individuals with obesity. The authors provide background on the physiological roles of the incretin hormones GIP and GLP-1 in the gastrointestinal tract, explaining how pharmacological analogues of these hormones, initially developed for type 2 diabetes, were subsequently found to produce clinically meaningful weight reduction. The review compares the three agents across efficacy, safety, cost-effectiveness, and real-world clinical trends. Lifestyle interventions (dietary modification, physical activity, sleep, and stress management) are discussed as foundational components of obesity management. The authors highlight that all three agents are now regulatory-approved for obesity in non-diabetic patients. As a narrative review, the paper synthesizes existing literature rather than generating new primary data, and is therefore subject to selection bias in the studies chosen. It does not conduct a formal systematic search or meta-analysis, limiting the objectivity of comparisons. No new clinical trial data are presented, and conclusions about relative efficacy and cost-effectiveness are drawn from the authors' interpretation of the existing evidence base.
Rambam Maimonides medical journal · Jan 2026DOI ↗ In vitro
This study developed and validated a stability-indicating High-Performance Liquid Chromatography (HPLC) method for the simultaneous quantification of two GLP-1 receptor agonists — Semaglutide (SEM) and Tirzepatide (TIR) — used in the treatment of type 2 diabetes and obesity. The method employed a C18 column with an isocratic mobile phase of 0.1% formic acid and acetonitrile (30:70), achieving rapid separation with retention times of 1.42 min for SEM and 1.68 min for TIR. The method was validated per ICH guidelines, demonstrating strong linearity (1–500 µg/mL, r > 0.9999), sensitivity (LOD: 10 ng/mL for TIR; 16 ng/mL for SEM), accuracy, and precision. The method successfully resolved both compounds from degradation products generated under acidic, basic, oxidative, and photolytic stress conditions. It was also applied to bulk drug, pharmaceutical dosage forms, and spiked rat plasma. A comprehensive six-pronged sustainability assessment was performed using nine analytical greenness, whiteness, blueness, and violet innovation tools. A key limitation is that the plasma work used spiked rat samples rather than real patient samples, meaning no clinical or pharmacokinetic conclusions about humans can be drawn.
BMC chemistry · Jan 2026DOI ↗ Moderate · human
This systematic review and meta-analysis examined the association between glucagon-like peptide-1 receptor agonists (GLP-1RAs) and heart rate (HR) changes in people with overweight or obesity who do not have diabetes. Researchers searched four major databases (PubMed, Web of Science, Embase, and Cochrane Library) and ultimately included 12 randomized controlled trials. Using both pairwise and network meta-analysis methods, the study calculated mean differences (MDs) in HR compared to placebo. Pairwise meta-analysis found that all analyzed GLP-1RAs — including liraglutide, semaglutide, orforglipron, oral semaglutide, tirzepatide, retatrutide, and the drug class overall — were associated with statistically significant increases in heart rate versus placebo. Network meta-analysis, which allows indirect comparisons across agents, suggested that orforglipron 36 mg was associated with the most pronounced HR increase, while tirzepatide 5 mg showed the least increase (and its result was not statistically significant). Key limitations include the indirect nature of network comparisons, variability in trial designs and follow-up durations, and the restriction to a non-diabetic population, which limits generalizability. The clinical significance of the observed HR increases was not fully addressed.
European journal of medical research · Jan 2026DOI ↗ Limited · human
This retrospective pharmacovigilance study analyzed FDA Adverse Event Reporting System (FAERS) data from Q1 2022 to Q3 2025 to compare gynecological hemorrhagic event reporting between tirzepatide (a dual GIP/GLP-1 receptor agonist) and semaglutide (a GLP-1 receptor agonist) in female patients. Researchers identified 103,607 female-specific reports—70,768 for tirzepatide and 32,839 for semaglutide—and calculated reporting odds ratios (RORs) using standardized MedDRA queries. The study found that gynecological hemorrhagic events were reported at nearly identical rates (0.60% for tirzepatide vs. 0.62% for semaglutide), with an ROR of 0.97 (95% CI: 0.82–1.14), indicating no statistically significant difference in reporting odds between the two agents. Notably, the authors flagged a substantial difference in reporter source composition: 94.6% of tirzepatide reports originated from consumers versus 53.4% for semaglutide, which may introduce bias and limits direct comparability. The authors concluded that no disproportionate safety signal was detected but emphasized that disproportionality analyses cannot establish causation, and that the consumer-reporting imbalance warrants cautious interpretation. Prospective, controlled studies were recommended to validate these findings.
Review
This commentary is aimed at clinicians and provides practical guidance for counseling patients who are hesitant about starting glucagon-like peptide-1 receptor agonist (GLP-1RA) therapy due to concerns about its perceived "newness" or unproven long-term safety. The paper briefly traces the history of GLP-1, from its discovery in the 1980s through nearly two decades of clinical use, to contextualize these agents as well-established rather than experimental. It distinguishes native GLP-1 from structurally modified agents such as semaglutide and tirzepatide, arguing that modifications prolong drug action without fundamentally changing the hormone's core mechanism. The authors summarize available safety data, noting that known side effects are predominantly mild and transient gastrointestinal in nature, and that there is currently no established evidence linking GLP-1RAs to feared risks such as cancer. The paper includes a practical counseling checklist and sample patient-friendly language intended to support shared decision-making conversations. Key limitations include the absence of original data, lack of systematic literature review methodology, and potential for author bias in evidence selection. Findings and reassurances are the authors' interpretive positions rather than conclusions drawn from a primary study.
American journal of preventive cardiology · Jan 2026DOI ↗ Review
This paper examines the growing use of glucagon-like peptide-1 (GLP-1) receptor agonists — specifically semaglutide and tirzepatide — in the context of obesity management. The authors discuss how these medications have meaningfully shifted the landscape of obesity care, while simultaneously raising important questions about their safety profile, long-term outcomes, and the risks associated with unregulated or compounded versions of these products. The paper highlights the tension between rapidly increasing patient demand and the need for robust clinical oversight. Key concerns addressed include adverse side effects, the consequences of unsupervised use, and the importance of coordinated clinical frameworks to ensure patients access these therapies safely. The authors advocate for structured monitoring systems and regulatory vigilance to keep pace with the surge in prescribing. As a review or commentary piece rather than an original clinical trial, the paper does not generate new primary data; its conclusions are based on synthesis of existing evidence and expert perspective. This limits its ability to independently establish causality or quantify risk with precision, and readers should interpret its claims in that context.
PLoS medicine · Jan 2026DOI ↗ Review
This paper examines the ethical dimensions of prescribing semaglutide (marketed as Ozempic, Wegovy, and Rybelsus) to children in the context of its expanding regulatory approvals for paediatric obesity management across several countries, including Germany, the UK, Denmark, and the United Arab Emirates. The authors explore tensions between the potential benefits of semaglutide — such as reducing cardiovascular risk and preventing obesity-related illness in children — and significant concerns including uncertainties about long-term safety, effects on child development, and unanswered efficacy questions in younger populations. The paper focuses particularly on three ethical challenges: access barriers and health equity, the risk of reinforcing weight-based stigma, and the tendency to overlook structural and social determinants of childhood obesity. The authors offer ethical recommendations for clinicians aimed at minimising harm, respecting children's autonomy, and promoting overall health. As an ethics and policy review paper, it does not present original clinical trial data, and its conclusions are based on normative argument and synthesis of existing literature rather than empirical evidence from controlled studies.
Archives of disease in childhood · Jan 2026DOI ↗ Limited · human
This retrospective, multi-centre observational study used the TriNetX global healthcare research network to compare outcomes of oral semaglutide versus sitagliptin in patients with heart failure with preserved ejection fraction (HFpEF) and type 2 diabetes (T2D). From a pool of over 800,000 patients with both conditions, 3,470 initiated oral semaglutide and 22,840 initiated sitagliptin between October 2019 and December 2023. After propensity score matching (3,452 patients per group), the study found that the oral semaglutide group had a significantly lower 1-year all-cause mortality rate (4.3% vs. 7.0%, log-rank p < 0.001) and lower rates of hospitalisation compared with the sitagliptin group. Important limitations include the observational, non-randomised design, which introduces potential for residual confounding despite propensity score matching; the reliance on administrative/claims data from the TriNetX platform; and the inability to confirm medication adherence or establish causality. The authors note that prior evidence for semaglutide in HFpEF comes from injectable formulations, and these findings for the oral route remain hypothesis-generating pending randomised controlled trial confirmation.
Diabetes, obesity & metabolism · Jan 2026DOI ↗ Review
This narrative review synthesizes mechanistic and clinical trial evidence on incretin-based therapies — GLP-1 receptor agonists (GLP-1RA), DPP-4 inhibitors, and newer dual/triple agonists — for cardiovascular (CV) and renal protection in type 2 diabetes (T2DM) and related conditions. The authors draw on multiple pivotal randomized cardiovascular outcome trials (CVOTs), including SELECT (semaglutide in obesity without diabetes), FLOW (semaglutide in chronic kidney disease), SOUL (oral semaglutide in T2DM with ASCVD/CKD), and SURPASS-CVOT (tirzepatide vs. dulaglutide). Key findings attributed to these trials include reductions in major adverse cardiovascular events (MACE), CV and all-cause mortality, heart-failure hospitalization, and hard kidney endpoints across GLP-1RA programs. A 2019 pooled analysis and a 2025 update reportedly confirm these cardiorenal benefits independent of baseline HbA1c. Mechanistically, the review describes GLP-1R signaling via Gs-cAMP/PKA, β-arrestin, and Gq pathways, linked to anti-inflammatory, natriuretic, and antifibrotic effects. Oral small-molecule GLP-1R agonists (e.g., orforglipron) showed phase 2 efficacy but lacked long-term outcome data at time of publication. As a narrative review, it is subject to selection bias and does not conduct formal meta-analytic pooling.
Diabetes therapy : research, treatment and education of diabetes and related disorders · Jan 2026DOI ↗ Review
This review examines the evolving landscape of glucagon-like peptide-1 receptor agonist (GLP-1RA) therapies and their role in cardiorenal protection in metabolic diseases, particularly type 2 diabetes (T2D) and obesity. The authors synthesize evidence from clinical and real-world studies demonstrating that GLP-1RAs consistently reduce HbA1c and body weight, and that mounting data support cardiovascular and kidney benefits beyond glycaemic control in high-risk populations. The review highlights that in T2D, GLP-1RAs have been shown to improve hard cardiovascular outcomes and, more recently, kidney outcomes. In individuals with obesity without T2D, semaglutide at a higher dose was reported to reduce body weight by up to 15% and lower major adverse cardiovascular events by approximately 20%. The review also covers next-generation "multi-agonist" molecules combining GLP-1 receptor agonism with activity at GIP, glucagon, and amylin receptors, aiming for complementary or synergistic metabolic effects. Tirzepatide, a dual GLP-1/GIP receptor agonist approved for T2D and obesity, is highlighted as achieving up to 22.5% weight loss in phase 3 trials. Limitations include the inherent constraints of a narrative review: no new primary data are generated, and conclusions depend on the scope and quality of included studies.
Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association · Jan 2026DOI ↗ 🧪 TrialInsufficient
Registered Phase 2 interventional trial (not yet recruiting). This research study is testing the effectiveness and safety of semaglutide (Wegovy) in people with trichotillomania, also known as hair-pulling disorder.
ClinicalTrials.gov · Dec 2025View trial ↗ Limited · human
This study describes the development and validation of a urine-based liquid chromatography–tandem mass spectrometry (LC-MS/MS) method for detecting semaglutide use in humans. Semaglutide is a GLP-1 receptor agonist originally approved for type 2 diabetes that has gained widespread use as a weight-loss aid. The authors note that semaglutide may confer a competitive advantage in weight-class sports (e.g., wrestling, boxing) by facilitating weight management, raising anti-doping concerns. The proposed method targets two unique urinary metabolites of semaglutide—designated U6 and U7—as biomarkers of exposure. Using only 2 mL of urine, the method achieved a reported limit of detection (LOD) of 50 pg/mL. The authors positioned this approach as a simpler alternative to existing blood-based testing regimens, given urine's relative ease of collection. Limitations include the absence of reported clinical validation data (e.g., pharmacokinetic profiling in dosed volunteers), no information on inter-individual variability, and no discussion of detection windows post-dose. The study is primarily an analytical methods paper rather than a clinical or pharmacological investigation.
Analytical and bioanalytical chemistry · Dec 2025DOI ↗ Moderate · human
The REDEFINE 1 trial was a phase 3a, 68-week randomized controlled trial that evaluated the blood pressure (BP) effects of CagriSema (a fixed-dose combination of semaglutide 2.4 mg and cagrilintide 2.4 mg) in 3,417 adults without diabetes who had overweight or obesity, with or without obesity-related complications. Participants were randomized to once-weekly CagriSema, semaglutide alone, cagrilintide alone, or placebo, alongside lifestyle intervention. Secondary and post hoc analyses focused on antihypertensive outcomes. The study found that CagriSema was associated with greater reductions in systolic BP (−10.9 vs. −2.8 mmHg) and diastolic BP (−5.4 vs. −1.7 mmHg) compared to placebo at week 68. A higher proportion of CagriSema participants reached BP targets (63.0% vs. 32.0%). Among those with resistant hypertension at baseline, BP target attainment was 42.0% vs. 29.3% (OR 1.7; 95% CI 0.7–4.4), though the confidence interval crossed 1. Notably, 39.6% of CagriSema participants on antihypertensive medications reduced or stopped treatment versus 18.8% with placebo. Limitations include that BP outcomes were secondary/post hoc endpoints, not primary, which limits causal inference strength for these specific findings.
Hypertension (Dallas, Tex. : 1979) · Dec 2025DOI ↗ Limited · human
This retrospective observational study used the TriNetX electronic medical records database to examine cardiovascular outcomes and safety of semaglutide compared with dipeptidyl peptidase-4 (DPP-4) inhibitors in patients with type 2 diabetes (T2D) who had a body mass index (BMI) below 25 kg/m². From a large cohort of 340,721 patients identified between 2018 and 2020, the researchers compared all-cause mortality, cardiovascular outcomes, and adverse events between the two treatment groups. The study found that semaglutide was associated with a lower 3-year risk of all-cause mortality compared with DPP-4 inhibitors in this non-overweight population. These findings are notable because most landmark GLP-1 receptor agonist cardiovascular outcome trials have predominantly enrolled overweight or obese participants, leaving the effects in leaner individuals less well understood. Key limitations include the retrospective, non-randomized design, which introduces potential confounding by indication, residual confounding from unmeasured variables, and reliance on administrative/electronic health record data. Generalizability may also be limited by the database's geographic and demographic composition. The authors attribute differences in outcomes specifically to the semaglutide versus DPP-4 inhibitor comparison within this BMI subgroup.
European heart journal. Quality of care & clinical outcomes · Dec 2025DOI ↗ Review
This narrative review examines the current and emerging landscape of GLP-1 receptor agonists (GLP-1RAs) as treatments for obesity and related metabolic conditions. The authors survey the three FDA-approved agents for obesity—liraglutide, semaglutide, and tirzepatide—alongside off-label options, summarizing evidence for their efficacy in weight reduction and glycemic control. The review also discusses expanding indications, including potential benefits in neurodegenerative disorders, fatty liver disease, dyslipidemia, atherosclerosis, cardiovascular disease, chronic kidney disease, and heart failure. Emerging pipeline agents—such as CagriSema, orforglipron, mazdutide, retatrutide, and survodutide—are highlighted alongside innovations like ultralong-acting formulations, combination therapies, higher-dose oral delivery, and AI-integrated drug development. The authors note that generic liraglutide and evolving insurance coverage may reshape affordability and access. Key limitations acknowledged include adherence challenges, safety concerns, disparities in global access, and the need for long-term data on sustained weight loss and disease modification. As a narrative review, the paper synthesizes existing literature rather than generating new primary data, and conclusions are therefore subject to the quality and selection of included studies.
Journal of obesity · Nov 2025DOI ↗ Animal only
This study investigated whether milk-derived small extracellular vesicles (sEVs) could serve as oral delivery vehicles for two GLP-1 receptor agonists (GLP-1RAs): semaglutide and tirzepatide. Researchers loaded both peptides onto sEVs in vitro and administered them orally to diabetic db/db mice—a well-established mouse model of type 2 diabetes. The study found that both peptides were efficiently incorporated into the sEV carrier system and that oral administration of the loaded vesicles effectively reduced blood glucose levels in the diabetic mice. The authors compared this approach to the existing SNAC (sodium N-[8-(2-hydroxybenzoyl) amino] caprylate) technology used in the commercially approved oral semaglutide formulation (Rybelsus), arguing that sEVs offer broader applicability across multiple peptide drugs, not just semaglutide. Key limitations include the exclusive use of an animal model with no human pharmacokinetic or efficacy data, a relatively small and homogeneous study design, and the early-stage, preclinical nature of the platform. Translation to humans remains undemonstrated.
Journal of extracellular biology · Nov 2025DOI ↗ Moderate · humanPreprint
This systematic review and meta-analysis (PROSPERO-registered) pooled data from four randomized controlled trials (n = 4,810 adults with overweight or obesity) to compare the fixed-dose combination of cagrilintide and semaglutide (CagriSema) against semaglutide alone, cagrilintide alone, or placebo. The authors found that, across all comparators, CagriSema was associated with statistically greater percent body weight reduction: approximately 7.4 percentage points more than semaglutide, 8.8 percentage points more than cagrilintide, and 13.9 percentage points more than placebo. The likelihood of achieving ≥15% or ≥20% weight loss was reported to be 2–3 times higher with the combination. Waist circumference was also significantly reduced with CagriSema versus placebo (mean difference approximately −10.9 cm). No consistent differences in HbA1c were observed across comparisons. Gastrointestinal adverse events were more frequent with CagriSema, and treatment discontinuation rates were correspondingly higher in the combination group. Limitations include the small number of included trials (four), preprint status introducing risk of non-peer-reviewed data, and potential heterogeneity across trial designs and populations.
Unknown journal · Nov 2025DOI ↗