Liraglutide

New Delhi: For Dinyar N. Jalnawalla (60), a Pune-based lawyer and type-2 diabetes patient, taking the GLP-1 route has led to a steep reduction in her daily rapid insulin requirements, while her basal insulin has been phased out. Added benefits included notable weight loss, she shed 5 kg in just two weeks, while on Mounjaro , a dual GLP-1/GIP agonist. Similarly, Vijendra Baid, speaking on behalf of his 60-year-old mother, Chanchal Jain, who has type-2 diabetes , says GLP-1 therapies have been a “lifesaver.” They helped her avoid increasing insulin doses and the associated weight gain—her weight dropped from 105 kg to 84 kg—while keeping her free of other complications. The common thread among these patients is the much-talked-about disruption in the diabetes domain: Glucagon-like Peptide-1 (GLP-1) receptor agonists, a newer class of medicines that harnesses the body’s own biology—specifically the gut hormone GLP-1—to manage blood sugar while also addressing a broader spectrum of metabolic comorbidities. With over 100 million people living with diabetes, the disease represents a colossal health challenge in India and on World Diabetes Day , ETPharma takes a close look at the ground-level impact of GLP-1 receptor agonists across India’s treatment landscape. In India, Dr. Ambrish Mithal , Chairman and Head, Endocrinology & Diabetes, Max Super Speciality Hospital, Saket, notes that the shift began nearly 20 years ago with the introduction of Exenatide, followed by range of therapies including Liraglutide, Dulaglutide, Semaglutide and, most recently, Tirzepatide. While earlier therapies were useful in managing diabetes, newer entrants like Semaglutide stand out for their ability to target visceral (belly) fat—a major driver of type-2 diabetes and metabolic complications. According to Dr. Aasim Maldar, Consultant Endocrinologist and Diabetologist, P. D. Hinduja Hospital & Medical Research Centre, Mumbai, clinicians typically see an average glucose reduction of 1.5 per cent to two per cent after three to four months of GLP-1 therapy. On managing multiple conditions, Dr. Priya Parekh (45), a Pune-based doctor living with type-2 diabetes, hypothyroidism, and anemia, says, “ Mounjaro (Tirzepatide) has helped me achieve normalized blood reports for diabetes, thyroid function, and other metabolic parameters.” Though not classified as obese with a BMI of 26.1, Akshay Kamath (46) from Thane—on insulin since 2011—experienced a 30 per cent reduction in his insulin requirement within three weeks of starting Mounjaro. Meanwhile, for Snehal Nandagawli, a Mumbai-based IT professional living with type-1 diabetes for the past 23 years, starting Rybelsus (oral Semaglutide) 3 mg in May this year for weight and cholesterol management led to better blood sugar control and a reduction of about “40 per cent” in her insulin needs. Dr. Maldar adds that with the addition of GLP-1 receptor agonists, sulfonylurea doses (oral drugs for type-2 diabetes) have been cut in half, while insulin requirements have also decreased. While the use of other diabetes medications has not declined significantly, Dr. Mithal notes, “GLP-1s now occupy one of the top spots alongside SGLT2 inhibitors, an oral therapy that limits glucose reabsorption in the body. However, the two main deterrents to using them as first-line treatments remain their cost and potential gastrointestinal side effects.” In type-1 diabetes, a condition caused by an absolute lack of insulin experts say GLP-1 therapies can help reduce insulin requirements and improve metabolic control, especially in overweight patients. However, their use must remain strictly under specialist supervision. Convenience Curve While the current buzz surrounds blockbuster injectables, particularly the once-weekly Mounjaro, doctors say that over time, patient preference may shift toward oral pills if formulations with comparable effectiveness become available. However, patients remain divided, given that options like Rybelsus require strict dosing—taken once daily on an empty stomach. Nandagawli says Rybelsus has been effective but requires strong body-awareness and careful insulin adjustments when living with type-1 diabetes. “It is not a set-and-forget therapy,” she says. Speaking for his mother, Baid notes that while she was on Rybelsus 14 mg, she often missed her morning doses, though it did not impact her significantly. Injectables, on the other hand, are once-weekly and easier to adhere to. Meanwhile, Nandagawli says she still prefers Rybelsus over injectables like Wegovy or Mounjaro because of the flexibility. “If I feel unwell, nauseous, or if I'm travelling, I can skip or stop the oral tablet temporarily—something not possible with weekly injections that stay in your system for days,” she said, adding that this flexibility helps her manage hormonal fluctuations like menstruation. “With weekly injectables, it would be much harder to adjust plans within the week.” WHO Endorsement Recognising strong scientific evidence for reducing premature mortality, in September the World Health Organisation (WHO) added four GLP-1 molecules—Liraglutide, Dulaglutide, Semaglutide, and Tirzepatide—to its Essential Medicines List for treating type-2 diabetes. The UN agency’s endorsement follows sustained advocacy by Indian patient-rights groups and sets a precedent for countries, including India, to add the therapies to their national lists. Nupur Lalvani, founder of the Mumbai-based Blue Circle Diabetes Foundation, emphasizes that this inclusion is a vital step, as the National List of Essential Medicines (NLEM) guides state governments in procuring and distributing medicines in public health facilities. She stressed that the inclusion of GLP-1s must not suffer delays like the case of Lantus—a long-acting insulin by Sanofi—which took more than three years to be added. Currently in India, a strip of 10 Rybelsus tablets costs ₹3,900, while injectable therapies like Mounjaro (Tirzepatide) and Wegovy (Semaglutide) range between ₹14,000–₹27,500 and ₹10,850–₹16,400, respectively, depending on the dosage. As drugmakers race to enter the GLP-1 market—through generics or novel innovations, Dr. Mithal stresses that the role of these therapies is expanding. The surge in injectables like Mounjaro and Wegovy, he says, is “just the tip of the iceberg.” He discourages their cosmetic use but notes the enormous potential market and predicts that their adoption will grow exponentially over time. By Abhijeet Singh ,

Results, presented at ObesityWeek® 2025, showed patients receiving NG101 saw 40% reduction in nausea incidence and 67% reduction in vomiting incidence Only 30% of patients who start GLP-1s for weight loss are still using them after one year, with GI side effects cited as the #1 cause of treatment discontinuationNG101 is a first-in-class therapy being evaluated for GLP-1-induced nausea and vomiting, the source of billions of dollars in annual lost revenues WOBURN, Mass., Nov. 07, 2025 (GLOBE NEWSWIRE) -- Neurogastrx, Inc., today presented proof-of-concept data from its placebo-controlled Phase 2 clinical study of NG101 (metopimazine mesylate), an oral, peripherally restricted dopamine D2 receptor antagonist for the treatment of GLP-1-induced nausea and vomiting. These data, shared in an oral presentation at ObesityWeek® 2025, demonstrated that NG101 significantly reduced the incidence, duration, and severity of nausea and vomiting associated with the use of a GLP-1 agonist. “GLP-1 agonists can be life-changing for individuals with obesity. Yet for so many, the common GI side effects of nausea and vomiting are often unbearable, leading to patients discontinuing treatment or being unable to reach optimal doses,” said Sean Wharton, MD, PharmD, Medical Director, Wharton Medical Clinic for Weight and Diabetes Management, Ontario, Canada, and an adjunct professor at both McMaster University in Hamilton and York University in Toronto. “An oral treatment such as NG101 may make GLP-1 receptor agonists tolerable for many patients.” Key Results from Clinical Study of NG101 for Semaglutide-Induced Nausea and Vomiting In the study, a total of 90 participants aged 18-55 received a single subcutaneous dose of semaglutide (0.5 mg), along with five days of NG101 20 mg twice per day (BID) or placebo. The study evaluated the efficacy of NG101 in reducing the incidence, duration, and severity of nausea and vomiting. Key clinical study results showed that, compared to placebo, NG101 significantly: Reduced the incidence of nausea by 40% (p=0.0203)Decreased the incidence of vomiting by 67% (p=0.0274) and the number of discrete vomiting episodes by 56% (p=0.0238)Reduced the duration of nausea and vomiting (p=0.0063); events lasting more than one day occurred in 22% vs. 51% of participants with NG101 vs. placeboDecreased nausea severity by 70% (p=0.0138) as reported by the participant Among participants who received NG101 vs. placebo, there were also substantially fewer adverse events, resulting in an improved safety profile when semaglutide is co-administered with NG101. Participant-reported outcomes (PROs) in the study revealed a greater symptom burden of nausea and vomiting than clinical assessments suggested. Clinicians graded less than five incidents of nausea and vomiting as moderate or severe, while 70 patients graded themselves as having moderate or severe symptoms at any time (n=90). PROs showed that NG101 reduced the maximum nausea rating of moderate-severe nausea by 31% (p=0.0225). The U.S. Food and Drug Administration (FDA) prioritizes the PRO measure for nausea and vomiting as it more accurately reflects the participant experience. “Nausea and vomiting associated with GLP-1s prevent millions of patients globally from fully realizing the benefits of this transformative class of medicines,” said Jim O’Mara, president and CEO of Neurogastrx. “The real-world incidence of nausea and vomiting reported by patients is far more significant and disruptive than the investigator-reported events in clinical trials. The significant reductions in nausea and vomiting that we’re seeing with NG101, combined with a clean safety profile, support its future clinical development and evaluation with multiple GLP-1 treatments. Individuals who are taking GLP-1s for weight loss deserve to have access to sustainable and tolerable treatments.” A study published in JAMA Network Open in January showed the one-year discontinuation rate of GLP-1 receptor agonists (liraglutide, semaglutide, or tirzepatide) for patients without type 2 diabetes was 64.8%, with GI events being the most frequent reason cited.1 “With the global GLP-1 market estimated at $63 billion in 2025, the sector is losing significant numbers of patients due to nausea and vomiting — and, more importantly, these patients are missing out on the clear benefits of weight loss on overall health, including metabolic and cardiovascular diseases associated with obesity.” About NG101 NG101 is an oral, small molecule peripherally acting dopamine D2 receptor antagonist. Neurogastrx recently completed a proof-of-concept safety and efficacy study of NG101 in nausea and vomiting associated with glucagon-like peptide 1 (GLP-1) agonists. GLP-1 agonists primarily activate two areas in the brain. Activation of the Nucleus of the Tractus Solitarius (NTS) causes satiety (leading to weight loss) whereas activation of the Area Postrema (AP) causes nausea and vomiting. The NTS resides inside the brain and is therefore not accessible to NG101. By contrast, the AP is located outside the blood-brain barrier and represents an ideal target for NG101. The AP is rich in dopamine D2 receptors. By selectively targeting the AP and blocking D2 receptors, NG101 blocks the symptoms of nausea and vomiting triggered by GLP-1 agonists. Details on the Phase 2 clinical study design can be found on www.clinicaltrials.gov (NCT06500429). About Neurogastrx, Inc. Neurogastrx, Inc. is a privately held specialty pharmaceutical company developing transformative therapies to advance the treatment of GI disorders for which meaningful therapeutic innovation is required to satisfy unmet patient need and disease burden. Media ContactAmanda BreedingScient PRamanda@scientpr.com 1 JAMA Netw Open. 2025 Jan 31;8(1):e2457349.