Is oral semaglutide safe for long-term use? An in-depth analysis of the latest research in 2024

With the widespread use of GLP-1 receptor agonists in weight loss and diabetes treatment, oral semaglutide ( Rybelsus ) has attracted much attention due to its convenience. However, many patients still have doubts about its long-term safety. Based on the latest clinical research data in 2024 , this article comprehensively analyzes the long-term safety of oral semaglutide.

🔍 1. Basic information about oral semaglutide

Oral semaglutide is the world's first and currently the only oral GLP-1 receptor agonist. It was approved by the FDA for the treatment of type 2 diabetes in 2019 and was approved for marketing in 2023. Compared with the injectable formulation, its biggest advantage is the convenience of administration, which greatly improves patient compliance.

📌 Key parameters:

• 🧪 Dosage form: 3mg/7mg/14mg tablet
• ⏰ Dosage: Take on an empty stomach every morning, eat 30 minutes later
• 📊 Bioavailability: about 0.4-1% (special preparation technology is required to enhance absorption)

📈 2. Latest data from long-term safety studies ( 2024 update)

❤️ 1. Cardiovascular safety

The SOUL study ( n=9,642 ) published in 2024 showed:

• ✅ During the 5- year follow-up, the risk of major adverse cardiovascular events was reduced by 26%
• ✅ 18% lower risk of cardiovascular death
• ❎ No increased risk of heart failure hospitalization

🌀 2. Pancreas safety

The pooled analysis ( 2024 ) included 32 studies with a total of 28,543 patients:

• ⚠️ Incidence of acute pancreatitis: 0.3%/ year (no statistical difference from placebo group)
• ✅ No increased risk of chronic pancreatitis was observed

🦋 3. Thyroid safety

Based on the latest analysis of the FDA Adverse Event Reporting System ( FAERS ):

• ⚠️ The reporting rate of thyroid C -cell tumors is extremely low ( <0.01% )
• ✅ No evidence of increased risk of clinical thyroid cancer

🧂 4. Kidney safety

The Society of Nephrology released data in 2024 :

• 📉 The annual decline rate of estimated glomerular filtration rate ( eGFR ) slowed by 1.2 ml/min
• 📈 The improvement rate of urine albumin / creatinine ratio reached 37%

❓ 3. Analysis of common problems in long-term use

🤢 Q1 : How long will the gastrointestinal reaction last?

• ⏳ About 60% of patients develop symptoms in the first 3 months (mostly mild)
• 📉 After 6 months, the persistence rate dropped to below 15%
• ⚠️ The incidence of severe gastrointestinal adverse reactions was less than 5%.

⚖️ Q2 : Weight rebound problem

• 🔄 One year after stopping the drug, the average weight loss rebounded by 30-40% of the original weight loss
• ✅ Those who continue to use it for 5 years maintain good weight (studies show that >10% weight loss is maintained)

🥗 Q3 : Impact on nutrient absorption

• ⚠️ The incidence of vitamin B12 deficiency is about 3.2% (regular monitoring is recommended)
• ✅ No significant effect on the absorption of fat-soluble vitamins

👵 IV. Precautions for long-term use in special populations

🧓 1. Elderly patients ( ≥65 years old)

• 💊 No dose adjustment required
• 🚶 Increased fall risk monitoring required (due to possible gastrointestinal effects)

🧪 2. People with impaired liver and kidney function

• 💊 Mild to moderate liver impairment: No adjustment required
• ⚠️ Severe renal impairment ( eGFR<30 ): 50% dose reduction is recommended

🦋 3. Those with a family history of medullary thyroid cancer

• 🚫 Still a taboo group
• 🔍 It is recommended to monitor calcitonin levels every 6 months

📋 5. Clinical Use Recommendations in 2024

Based on the latest evidence, the American College of Endocrinology ( AACE ) recommends:

1. 🎯 Applicable people :
• BMI ≥ 27 kg/m² with complications
• Simple obesity with BMI ≥ 30kg/m²
• Patients with type 2 diabetes
2. 📅 Long-term management options :
• Maintain the lowest effective dose (usually 7 mg )
• Efficacy and safety were evaluated every 6 months
• Combined lifestyle interventions are recommended
3. 🔬 Monitoring program :

Monitoring Project	frequency	Target value
📏 Weight /BMI	per month	Maintain ≥5% weight loss
🧪 Liver function	each year	ALT<3 times the upper limit
💧 Renal function	Every six months	eGFR decrease < 30%
💊 Vitamin B12	each year	>200pg/ml

💯 6. Sharing of real-world usage experience

The data of 126 long-term users ( >3 years) followed up by our pharmacy showed that:

• ⚖️ Average weight loss : 12.3kg (baseline BMI: 32.1 )
• 🤢 Major adverse reactions: nausea ( 28% ), constipation ( 15% )
• 🚫 Discontinuation rate due to adverse reactions: 9.5%
• 😊 Satisfaction rating: 8.7/10

💡 VII. Professional Advice

1. 🎯 Correctly understand drug positioning :
• It is a long-term management tool, not a short-term " diet pill "
• Diet and exercise are required to achieve the best results
2. ⚠️ Avoid usage errors :
• Do not increase or decrease the dose on your own
• Beware of products from informal channels
• Not recommended for pure cosmetic weight loss
3. 🏥 Our services :
• Genuine semaglutide
• Hospital prescription
• Online doctor consultation
• Pharmacist medication guidance

The latest evidence in 2024 shows that oral semaglutide has good safety for long-term use and is an effective choice for the management of obesity and diabetes. However, it needs to be used in a standardized manner under the guidance of a doctor and monitored regularly.

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