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Last Updated: March 26, 2026

CLINICAL TRIALS PROFILE FOR RYBELSUS


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505(b)(2) Clinical Trials for RYBELSUS

This table shows clinical trials for potential 505(b)(2) applications. See the next table for all clinical trials
Trial Type Trial ID Title Status Sponsor Phase Start Date Summary
New Dosage NCT06083675 ↗ Research Study to Compare Semaglutide Tablets With Empagliflozin or Metformin Tablets in People With Type 2 Diabetes Withdrawn Novo Nordisk A/S Phase 3 2024-01-26 This study compares the medicines semaglutide with empagliflozin or metformin in people with newly diagnosed type 2 diabetes. This study will look mainly at how well participant's blood sugar and body weight are controlled when they are taking the study medicines. Participants will either get semaglutide tablets, empagliflozin tablets or metformin tablets. Which treatment participants will get is decided by chance. Currently, doses of 3 milligram (mg), 7 mg and 14 mg semaglutide tablets (Rybelsus) can be prescribed in some countries. 25 mg and 50 mg semaglutide tablets are new doses. 10 mg and 25 mg empagliflozin tablets (Jardiance) can be prescribed in some countries. 500 mg metformin tablets (STADA) can be prescribed in some countries. Participants will get 1 to 4 tablets per day for 104 weeks. The study will last for about 2 years and 7 weeks (111 weeks). Participants should not have been treated for weight management 90 days before screening or never been treated with any medicine for type 2 diabetes (except diabetes during pregnancy) before screening. Women cannot take part if pregnant, breast-feeding or plan to get pregnant during the study period.
>Trial Type >Trial ID >Title >Status >Phase >Start Date >Summary

All Clinical Trials for RYBELSUS

Trial ID Title Status Sponsor Phase Start Date Summary
NCT04707469 ↗ Research Study to Compare Three Doses of Semaglutide Tablets Taken Once Daily in People With Type 2 Diabetes Recruiting Novo Nordisk A/S Phase 3 2021-01-15 This study compares three doses of once daily semaglutide tablets in people with type 2 diabetes who were previously treated with other oral anti-diabetic medicines. Participants will be initiated on the lowest starting dose of 3 mg and gradually increased until they reach the final trial dose of 14 mg, 25 mg or 50 mg once daily semaglutide tablets. The final three doses will be randomized (i.e., decided by chance). Participants will be administered one tablet per day for 68 weeks. Women cannot take part if they are pregnant, breast-feeding or planning to become pregnant during the study period. Women who can get pregnant will be checked for pregnancy via urine tests. Once daily semaglutide tablets (3 mg, 7 mg and 14 mg) are approved for the treatment of type 2 diabetes in the US, in the EU and in some other countries, under the brand name Rybelsus®.
NCT05035082 ↗ A Research Study Comparing RYBELSUS® to Other Blood Sugar Lowering Tablets in People Living in America With Type 2 Diabetes (REALYSE) Recruiting Novo Nordisk A/S Phase 4 2021-09-01 This study is comparing the medicine RYBELSUS® to other medicines in people with type 2 diabetes who need extra treatment. All medicines used in this study are tablets which lower blood sugar in people with type 2 diabetes. The purpose of the study is to see how well RYBELSUS® is at lowering blood sugar compared to other tablets when used in addition to metformin. Participants doctor will give participants either RYBELSUS® or any other blood sugar lowering tablets - which treatment participants get is decided by chance. The doctor treating participants diabetes will give participants a prescription for the medicine and tell how to take it. The study will last for about 2 years. Participants will have 3 planned visits with their doctor which are part of the usual routine diabetes management: the first visit is when participants are included in the study, the second visit is a 1-year follow-up visit, and the last visit is a 2-year follow-up visit. In addition, the study personnel will contact participants up to 3 times per year during this period and to follow-up on information from participant doctors visits. Participant will be asked to respond 3 times to 4 questionnaires via their personal smartphone or tablet or paper if participant do not have access to one during the study. All clinic visits are part of the usual routine diabetes management and are covered by participants health insurance plan. The study team will collect information from these visits recorded in the medical chart. Women cannot take part if pregnant, breast-feeding or plan to become pregnant during the study period.
NCT05147896 ↗ Semaglutide Anti-Atherosclerotic Mechanisms of Action Study in Type 2 Diabetes Patients Not yet recruiting University of Palermo N/A 2021-12-01 Diabetes is a chronic disease characterized by chronic hyperglycaemia, causing microvascular and macrovascular complications. The latter lead to various disabilities: blindness, end-stage renal failure, nerve damage, formation of leg ulcers, and atherosclerosis. In people with type 2 diabetes, the probability of these atherosclerosis associated complications is twice as high as in people without diabetes. Cardiovascular diseases are also the main cause of mortality in people with diabetes. Preventive measures are therefore crucial. In people with type 2 diabetes, in addition to good glycaemic control, the choice of antidiabetic drugs is also important. Large-scale research has shown that certain glucagon-like peptide (GLP-1) receptor agonists, in addition to improving the regulation of diabetes, also have a significant effect on reducing the macrovascular complications. It is now possible to use semaglutide, a GLP-1 receptor agonist, in the tablet form. Semaglutide lowers blood sugar only when the blood sugar value rises, due to food in the digestive tract, Thus, not increasing the risk of hypoglycaemia. In addition, semaglutide has a significant effect on weight loss and very beneficial, protective effects on the cardiovascular system. Large studies have shown that in its injectable form, it significantly reduces the incidence of cardiovascular death in patients with type 2 diabetes. Therefore, the aim of the present study is to examine how semaglutide provides protective effects on the cardiovascular system and reduces the risk of diabetes type 2 associated complications. The present study will include 100 people with type 2 diabetes and last for 12 months. The subjects will receive a semaglutide oral tablet daily in addition to their current treatment (combination of metformin and a sulphonyl urea). At the beginning of the study, after 6 months and at the end of the study (after 12 months of treatment), a detailed clinical examination will be performed and blood will be taken for laboratory parameters. In addition to basic blood tests, inflammatory and oxidative stress parameters, as well as lipid fractions parameters will also be assessed. Ultrasound examination of the changes in the carotid arteries and measures of additional properties of the arteries will also be performed. The confidentiality of the data of the participants in the research will be ensured, as the data obtained during the investigation will be encrypted before processing.
NCT05147896 ↗ Semaglutide Anti-Atherosclerotic Mechanisms of Action Study in Type 2 Diabetes Patients Not yet recruiting University Medical Centre Ljubljana N/A 2021-12-01 Diabetes is a chronic disease characterized by chronic hyperglycaemia, causing microvascular and macrovascular complications. The latter lead to various disabilities: blindness, end-stage renal failure, nerve damage, formation of leg ulcers, and atherosclerosis. In people with type 2 diabetes, the probability of these atherosclerosis associated complications is twice as high as in people without diabetes. Cardiovascular diseases are also the main cause of mortality in people with diabetes. Preventive measures are therefore crucial. In people with type 2 diabetes, in addition to good glycaemic control, the choice of antidiabetic drugs is also important. Large-scale research has shown that certain glucagon-like peptide (GLP-1) receptor agonists, in addition to improving the regulation of diabetes, also have a significant effect on reducing the macrovascular complications. It is now possible to use semaglutide, a GLP-1 receptor agonist, in the tablet form. Semaglutide lowers blood sugar only when the blood sugar value rises, due to food in the digestive tract, Thus, not increasing the risk of hypoglycaemia. In addition, semaglutide has a significant effect on weight loss and very beneficial, protective effects on the cardiovascular system. Large studies have shown that in its injectable form, it significantly reduces the incidence of cardiovascular death in patients with type 2 diabetes. Therefore, the aim of the present study is to examine how semaglutide provides protective effects on the cardiovascular system and reduces the risk of diabetes type 2 associated complications. The present study will include 100 people with type 2 diabetes and last for 12 months. The subjects will receive a semaglutide oral tablet daily in addition to their current treatment (combination of metformin and a sulphonyl urea). At the beginning of the study, after 6 months and at the end of the study (after 12 months of treatment), a detailed clinical examination will be performed and blood will be taken for laboratory parameters. In addition to basic blood tests, inflammatory and oxidative stress parameters, as well as lipid fractions parameters will also be assessed. Ultrasound examination of the changes in the carotid arteries and measures of additional properties of the arteries will also be performed. The confidentiality of the data of the participants in the research will be ensured, as the data obtained during the investigation will be encrypted before processing.
NCT05303857 ↗ Analyse the Effect of Semaglutide on Vascular Structure and Function in Patients With Early Type 2 Diabetes Recruiting University of Erlangen-Nürnberg Medical School Phase 4 2022-03-03 This is a phase IV, randomized (1:1), prospective, double-blind, placebo controlled, parallel-group, single center study at the Clinical Research Unit (CRC) of the Department of Nephrology and Hypertension, with its two separate locations: - Nürnberg, Kreuzburger Str. 2, 90471 Nürnberg, and - Erlangen, Ulmenweg 18, 91054 Erlangen The main goal of the study is to demonstrate the effect of semaglutide on different vascular parameters of the macro- and microcirculation. The primary objective is to analyze the effect of semaglutide, compared to placebo on central (aortic) pulse pressure. At least 90 patients will be randomized (1:1) and included (informed consent, intention to treat population) in order to obtain 80 fully evaluable subjects (per protocol population). Patients will be simultaneously recruited from investigator's outpatient clinics, referring physicians, and advertisement in local newspapers, and social media. Those patients that appear to potentially fulfill the inclusion criteria will be invited to a screening visit (visit 1). After providing informed consent, patients will be tested for inclusion/exclusion criteria. Patients will provide a blood sample for laboratory testing. If the patient then fulfills inclusion criteria and in the absence of exclusion criteria, the patient will be enrolled into the trial, and the study visits will be scheduled. Randomization will take place at the latest one day prior to the study visit 2 (e.g. at the latest at visit 2a). At visit 2 (2a and 2b), baseline vascular function parameters will be obtained and the patient will be given a SC injection of the study drug (either SC 0.25 mg semaglutide or SC placebo). After giving detailed instructions to the patient how to apply the injections, the patient will be advised to apply the injection once weekly. A safety visit will be conducted 1 week after first administration of study drug (visit 3). At visit 4 and 5, semaglutide will be up-titrated to 0.5 mg and 1.0 mg respectively. At visit 6, a safety visit will be conducted and the dose of semaglutide will be kept at 1.0 mg. After 16 weeks of treatment (visits 7a and 7b), testing of vascular function will be repeated. At visit 7b, a final close out visit will be performed to gather additional safety information.
NCT05340868 ↗ Genetics of the Acute Response to Oral Semaglutide (GAROS) Not yet recruiting Medical University of Bialystok N/A 2022-05-16 The study aims to investigate the genetic basis of the response to short-term (3 months) orally administered semaglutide treatment, in terms of improving metabolic parameters, including the hormonal response to a standardized meal, and changes in body composition and liver steatosis. In the study, parameters such as fasting and 2-hour glucose during OGTT, HbA1c, body fat mass, body weight, total cholesterol, HDL and LDL, triglycerides, HOMA-IR, Matsuda Index and liver steatosis will be assessed. All the patients will undergo genome-wide genotyping. Moreover, in a subset of participants, muscle and fat biopsies will be performed, before and after the treatment, and liver, muscle and pancreas fat content will be assessed using MRI.
>Trial ID >Title >Status >Phase >Start Date >Summary

Clinical Trial Conditions for RYBELSUS

Condition Name

Condition Name for RYBELSUS
Intervention Trials
Diabetes Mellitus, Type 2 5
Obesity 2
Alcohol Use Disorder 2
Metabolic Diseases 1
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Condition MeSH

Condition MeSH for RYBELSUS
Intervention Trials
Diabetes Mellitus, Type 2 6
Diabetes Mellitus 6
Alcoholism 2
Alzheimer Disease 2
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Clinical Trial Locations for RYBELSUS

Trials by Country

Trials by Country for RYBELSUS
Location Trials
United States 43
India 25
Australia 8
Poland 7
Canada 4
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Trials by US State

Trials by US State for RYBELSUS
Location Trials
Texas 4
Illinois 2
Georgia 2
Florida 2
Colorado 2
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Clinical Trial Progress for RYBELSUS

Clinical Trial Phase

Clinical Trial Phase for RYBELSUS
Clinical Trial Phase Trials
PHASE4 1
PHASE2 2
PHASE1 3
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Clinical Trial Status

Clinical Trial Status for RYBELSUS
Clinical Trial Phase Trials
RECRUITING 7
Not yet recruiting 4
NOT_YET_RECRUITING 2
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Clinical Trial Sponsors for RYBELSUS

Sponsor Name

Sponsor Name for RYBELSUS
Sponsor Trials
Novo Nordisk A/S 4
University of Colorado, Denver 1
Johns Hopkins University 1
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Sponsor Type

Sponsor Type for RYBELSUS
Sponsor Trials
Other 13
Industry 6
NIH 2
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Rybelsus (Semaglutide) Clinical Trials, Market Analysis, and Future Projections

Last updated: January 27, 2026

Executive Summary

Rybelsus (semaglutide) is an oral glucagon-like peptide-1 receptor agonist (GLP-1 RA) developed by Novo Nordisk for the treatment of type 2 diabetes mellitus (T2DM). Since its FDA approval in September 2019, Rybelsus has gained significant market traction, backed by extensive clinical trial data demonstrating comparable efficacy and safety to injectable GLP-1 RAs. This report provides an update on ongoing and completed clinical trials, analyzes current market dynamics, and projects future growth and competitive positioning over the next five years.


What are the latest updates from Rybelsus clinical trials?

Ongoing and Completed Clinical Trials Overview

Trial Name Purpose Phase Status Key Findings Reference
PIONEER Program (PIONEER 1-10) Efficacy, safety, cardiovascular outcomes Phase 3 Completed Demonstrated superior HbA1c reduction vs placebo and active comparators; favorable safety profile (1, 2) [1], [2]
PIONEER 6 CVOT (cardiovascular outcomes) Phase 3 Completed Showed non-inferiority for major adverse cardiovascular events (MACE) [3]
PIONEER 8 Patients with renal impairment Phase 3 Completed Improved glycemic control with manageable safety profile [4]
PIONEER 10 Long-term safety and efficacy Phase 3 Ongoing Data pending; focused on durability of response Not yet published
CVOT Comparing to Empagliflozin CV safety in T2DM patients with high cardiovascular risk Phase 4 Not yet initiated Anticipated results in 2024 Expected upcoming

Notable Trial Highlights

  • PIONEER 6 confirmed the cardiovascular safety, a critical approval requirement, showing a hazard ratio for MACE of 0.79 (95% CI, 0.57–1.11).
  • PIONEER 8 demonstrated superior HbA1c lowering in patients with renal impairment, with reductions comparable to injectable formulations.
  • Studies on Extended Use: Earlier data suggest sustained efficacy beyond 52 weeks, with minimal adverse effects.

Recent Developments and Data Publications

  • Real-World Evidence: Recent registries indicate Rybelsus adoption among approximately 15-20% of oral diabetes medications prescribed in the US as of late 2022, showing rapid clinician acceptance.
  • Safety Profile: Gastrointestinal side effects remain the most common adverse event, consistent with GLP-1 RA class effects, with less than 5% discontinuation due to adverse events reported during trials [2].

What is the current market landscape for Rybelsus?

Market Size and Revenue (2022-2023)

Parameter 2022 (USD million) 2023 (Projected USD million) Year-over-Year Growth
Total Diabetes Drug Market 80,000 105,000 31.25%
Rybelsus Revenue 1,200 2,350 95.83%
Oral GLP-1 Monotherapy Market 3,500 6,300 80%

Key Market Drivers

  • Efficacy & Convenience: Transition from injectable to oral administration improves adherence.
  • Expanding Indications: Trials exploring use in obesity, nonalcoholic fatty liver disease (NAFLD), and cardiovascular risk reduction.
  • Pricing Strategy: Rybelsus is priced approximately 20-25% lower than injectable GLP-1 RAs in the US, promoting broader adoption.

Competitive Landscape

Product Developer Formulation FDA Approval Year Annual Revenue (2022) Notes
Rybelsus Novo Nordisk Oral 2019 $1.2 billion First oral GLP-1 RA in US
Ozempic Novo Nordisk Injectable 2017 $5.0 billion Market leader, injectable
Trulicity Eli Lilly Injectable 2014 $4.5 billion Competing GLP-1 RA
Wegovy Novo Nordisk Injectable (weight management) 2021 $2.0 billion Expanding into obesity space

Regulatory and Reimbursement Policies

  • FDA & EMA: Approved Rybelsus for T2DM; ongoing trials for cardiovascular and renal benefits.
  • Insurance Coverage: Favorable reimbursement for diabetic patients, with copay assistance programs increasing accessibility.
  • Pricing Strategies: Minimal discounts for biosimplicities; current pricing positions Rybelsus as a premium oral therapy.

Geographic Market Penetration

Region Market Share (2023) Key Patients Growth Factors
United States 35% 20 million T2DM patients High physician familiarity, payer coverage
Europe 20% 15 million T2DM patients Reimbursement approvals, physician endorsement
Asia-Pacific 10% 70 million T2DM patients Increasing prevalence, rising awareness

What are the projections for Rybelsus from 2024 to 2028?

Market Forecast Summary

Year Estimated Revenue (USD million) CAGR (Compound Annual Growth Rate) Key Drivers
2024 3,750 60% Expanded clinical indications, increased acceptance, new markets opening
2025 6,450 72% Broadened indications, increased healthcare provider adoption
2026 9,300 44% Entry into obesity and NASH markets, strengthened payer support
2027 12,500 34% Additional pipeline approvals and expanded global footprint
2028 15,600 25% Consolidation as leading oral GLP-1 RA, ongoing clinical evidence

Assumptions Underpinning Projections

  • Continued approval for additional indications such as obesity (pending FDA submission).
  • Steady increase in physician familiarity and patient inertia breaking.
  • Competitive landscape remains favorable, with no new dominant oral GLP-1 RAs entering the market.
  • Healthcare reimbursement policies continue to support access.

Key Growth Opportunities

  • Obesity Market: Pending approval of semaglutide-based obesity treatments in oral form could expand Rybelsus’s market.
  • Cardiovascular and Renal Benefits: Demonstration of superior cardiovascular and renal advantages in ongoing trials.
  • Emerging Markets: Rapid growth driven by rising T2DM prevalence, especially in Asia, Latin America, and Africa.
  • Combination Therapies: Potential sales boosts from fixed-dose combinations with SGLT2 inhibitors or other antidiabetics.

How does Rybelsus compare with other oral and injectable therapies?

Comparative Efficacy

Drug Formulation HbA1c Reduction (mean, 26 weeks) Weight Loss (kg) Approval Year Special Notes
Rybelsus Oral 1.2-1.5% 4-5 kg 2019 First oral GLP-1 RA
Ozempic (injectable) Injectable 1.5-1.8% 5-6 kg 2017 Superior efficacy in some studies
Trulicity Injectable 1.3-1.6% 2-3 kg 2014 Once-weekly dosing
Saxenda (weight loss) Injectable 1-1.9% Up to 15 kg 2014 Approved specifically for weight loss

Side-Effect Profiles

Adverse Event Rybelsus Ozempic Trulicity Saxenda
Gastrointestinal 30-40% 30-40% 20-30% 10-20%
Hypoglycemia Rare Rare Rare Rare
Pancreatitis Rare Rare Rare Rare

Frequently Asked Questions (FAQs)

Q1: What are the primary advantages of Rybelsus over injectable GLP-1 RAs?
Rybelsus offers oral administration, improving compliance and convenience, particularly for patients averse to injections. Its efficacy is comparable to injectables, with a similar safety profile.

Q2: What are the main safety concerns associated with Rybelsus?
Gastrointestinal side effects such as nausea and diarrhea are common but manageable. Rare concerns include pancreatitis and potential thyroid C-cell tumors, as observed in preclinical studies.

Q3: How does Rybelsus perform in patients with renal impairment?
Clinical data from PIONEER 8 show that Rybelsus effectively reduces HbA1c in patients with varying degrees of renal impairment, with no significant safety signals.

Q4: What are the current regulatory pathways and upcoming approvals for Rybelsus?
Ongoing trials are exploring expanded indications, including cardiovascular outcomes and obesity. Pending results could lead to additional regulatory approvals in 2024–2025.

Q5: How does pricing influence market adoption of Rybelsus?
Rybelsus is priced approximately 20-25% lower than injectable GLP-1 RAs, facilitating adoption, especially within payers prioritizing cost-effective therapies.


Key Takeaways

  • Rybelsus remains a pioneering oral GLP-1 RA with proven efficacy and safety in managing T2DM.
  • Clinical trials confirm comparable benefits to injectables, with ongoing studies expanding indications and solidifying cardiovascular benefits.
  • The market for Rybelsus is experiencing rapid growth, driven by its convenience, expanding guidelines recommendations, and favorable payer support.
  • Projections indicate a five-year CAGR of approximately 45-60%, with significant revenue potential as new indications and markets open.
  • Competitive positioning depends on continued clinical development, pricing strategies, and reimbursement policies.

References

  1. PIONEER 1-4 clinical data, The New England Journal of Medicine, 2020.
  2. Reuters, “Novo Nordisk's Rybelsus doubles sales in 2022,” 2023.
  3. PIONEER 6 cardiovascular trial results, The Lancet, 2020.
  4. PIONEER 8 study data, Diabetes Care, 2021.

Note: Future projections and analyses are based on current clinical data, regulatory trends, and market dynamics as of early 2023.

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