Oral semaglutide for weight loss and liver fibrosis in overweight and obesity: A randomized controlled trial.
Anudeep Katrevula, Rakesh Kalapala, Siddhant Agrawal et al.
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In 30 seconds
This randomized, open-label, controlled trial compared oral semaglutide plus diet and activity counselling with counselling alone in adults with overweight or obesity without diabetes. At 28 weeks, mean percentage weight reduction was -10.47% (SD 5.3) with semaglutide versus -2.4% (SD 4.5) in controls (p < 0.001). Semaglutide was also associated with improvements in several metabolic measures and non-invasive liver markers, including liver fat and stiffness, although NFS and FIB-4 did not significantly decrease.
Key findings
- At 28 weeks, mean percentage weight reduction was -10.47% (SD 5.3) with semaglutide versus -2.4% (SD 4.5) in controls (p < 0.001).
- Total fat mass decreased by 7.3 kg with semaglutide versus 1.74 kg in controls (p < 0.0001).
- ALT, APRI, liver fat content and liver stiffness improved with semaglutide; NFS and FIB-4 did not show significant reductions.
- Improvements in BMI, waist circumference, HbA1c, fasting insulin and CRP were significantly greater with semaglutide (p < 0.001).
Why it matters
The trial suggests that oral semaglutide added to lifestyle counselling can produce greater short-term weight loss and improve several cardiometabolic and liver-related measures in adults with overweight or obesity who do not have diabetes. The differing results across fibrosis markers are important: improvements in some non-invasive measures do not establish a consistent effect on liver fibrosis.
What to keep in mind
The trial was open-label and conducted at a single centre. Follow-up was limited to 28 weeks, and liver outcomes were assessed using non-invasive markers.