Aim: To evaluate and compare the efficacy, safety, and immunogenicity of a synthetic semaglutide injection (Test semaglutide) with Wegovy (Reference semaglutide) injection for weight management.

Materials and Methods: This randomized, Phase III, non-inferiority study included adults with obesity or overweight with or without comorbidities from 21 centers in India. A total of 270 patients with body mass index ≥ 30 kg/m2 or ≥ 27 kg/m2 with the presence of at least one of the weight-related comorbidities (hypertension, dyslipidemia or type 2 diabetes mellitus) were randomized (2:1) to receive either Test semaglutide (N = 177) or Reference semaglutide injection (N = 90) once weekly with dose escalation from 0.25 to 2.4 mg. The primary endpoint was percentage change in body weight from baseline to Week 24.

Results: Out of 267 randomized patients, 246 completed the study. At Week 24, mean percent weight change from baseline was −13.8% ± 4.28% in Test and −14.1% ± 4.11% in Reference groups, with a least-squares mean difference of 0.26% (95% CI: −0.86% to 1.39%), meeting the criterion for non-inferiority. The proportion of patients with ≥ 5% and ≥ 10% weight loss was 96.40% and 80.60% in Test, and 98.80% and 80.00% in the Reference group, respectively, at Week 24. Improvements in body mass index, waist circumference, SF-36 total score, and glycemic parameters were comparable between groups. Treatment-emergent adverse events were reported in 72.30% and 76.70% in the Test and Reference groups, respectively, with gastrointestinal events being the most common.

Conclusions: Test synthetic semaglutide was found to be non-inferior to Reference semaglutide in weight management with or without comorbidities.

Yash Bahulikar, MBBS, MD (Internal Medicine), is a Consultant Physician with 17 years of experience in Internal Medicine. His clinical interests include diabetes and metabolic diseases, tropical illnesses, critical care, and medical emergencies. He has worked in rural Pune in diabetes care and has 5 years of experience as an ICU Intensivist. He currently practices as a Consultant Physician at two hospitals in Pune, alongside his private practice. He received the Best Thesis Award during his MD training for his work on dengue fever.