Last Updated: May 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↗ Research Study to Compare Semaglutide Tablets With Empagliflozin or Metformin Tablets in People With Type 2 Diabetes Withdrawn Novo Nordisk A/S Phase 3 2024-01-26 This study compares the medicines semaglutide with empagliflozin or metformin in people with newly diagnosed type 2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.
NCT05579977 ↗ Trial to Learn About the Study Medicine (PF-07081532) and Rybelsus in People With Type 2 Diabetes and Separately PF-07081532 in People With Obesity Not yet recruiting Pfizer Phase 2 2022-11-08 The purpose of this study is to find out if PF-07081532 ("the active study drug"), is safe and helps treat people with obesity without diabetes to lose weight, and people with diabetes to keep their blood sugar in good control. Individuals diagnosed with diabetes that are on metformin or individuals with obesity without diabetes will be included in the study. Those participating in the diabetes part of the study, will receive either active study drug, placebo, or an approved treatment called Rybelsus. Those in the obesity part of the study, will receive either active study drug or placebo. The study will last for about 36 weeks except for the first 25% of the participants that enter in which case the study will last for approximately 48 weeks. during this time there will be visits every 4 weeks with phone calls in between.
>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
Alcohol Use Disorder 2
Obesity 2
Genetic Predisposition 1
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Condition MeSH

Condition MeSH for RYBELSUS
Intervention Trials
Diabetes Mellitus, Type 2 6
Diabetes Mellitus 6
Alzheimer Disease 2
Glucose Intolerance 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
Pennsylvania 2
North Dakota 2
North Carolina 2
Massachusetts 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
The University of Texas Health Science Center at San Antonio 1
University of Erlangen-Nürnberg Medical School 1
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Sponsor Type

Sponsor Type for RYBELSUS
Sponsor Trials
Other 13
Industry 6
NIH 2
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Rybelsus (oral semaglutide) clinical trials update, market analysis, and projection

Last updated: April 28, 2026

Rybelsus (oral semaglutide) is the leading oral GLP-1 receptor agonist in multiple geographies, with ongoing line-extensions and competitive pressure from injectable GLP-1s and emerging oral incretin therapies. The near- to mid-term outlook is driven by: (1) conversion of injectable GLP-1 users into higher-value oral dosing where available, (2) expanded indications and combinations, and (3) the pace of supply and reimbursement coverage.


What is the current clinical development picture for Rybelsus?

Rybelsus is approved for type 2 diabetes. The clinical program behind oral semaglutide has been built around glycemic efficacy, weight loss, and cardiovascular risk reduction in type 2 diabetes populations, with additional studies evaluating broader metabolic outcomes and long-term durability.

Key clinical outcomes used for commercial positioning

Type 2 diabetes efficacy and durability (core program)

  • Rybelsus demonstrates sustained HbA1c lowering and clinically meaningful weight reduction versus comparators in phase 3 programs supporting approval and label expansions (clinical trial results reported by sponsor and regulators across the oral semaglutide development program).
  • Long-term cardiovascular outcomes for semaglutide in type 2 diabetes have been established in the cardiovascular outcomes program of semaglutide-class therapy, supporting payer confidence in risk reduction narratives when translating across administration routes (clinical evidence for cardiovascular risk reduction in type 2 diabetes is central to GLP-1 adoption).

Weight management relevance

  • Although Rybelsus is labeled for diabetes, its weight loss profile underpins off-label interest historically and supports eventual label expansion when regulators accept endpoint frameworks used across GLP-1 weight-loss indications.

Safety and tolerability profile (commercially actionable)

  • The dominant tolerability burden remains gastrointestinal events, which affects dose-escalation strategy, persistence, and switching behavior between oral and injectable GLP-1s.

Ongoing and future-facing trial themes (what to watch)

  • Cardiovascular and kidney outcomes: GLP-1 adoption increasingly hinges on outcomes in higher-risk cohorts. Future readouts are expected to target the same endpoints used for payer and formulary decisions (MACE, kidney composite endpoints, albuminuria metrics).
  • Combination regimens: Payer value improves when oral semaglutide is positioned against both GLP-1 monotherapy and “GLP-1 plus basal insulin” pathways.
  • Earlier-line use and titration optimization: Oral administration success depends on adherence and tolerability at scale; trials that tighten titration regimens and adherence support adoption.
  • Head-to-head and pragmatic studies: In late-stage development, the competitive question shifts from efficacy alone to persistence, adherence, real-world tolerability, and HbA1c trajectory under routine care.

Source anchor for semaglutide cardiovascular outcomes and label context is consistent across public clinical evidence for semaglutide-class products and regulatory reporting for oral semaglutide (see citations [1]-[3]).


How has Rybelsus performed commercially by geography and channel?

Rybelsus is sold in major markets and has scaled through diabetes prevalence and formulary inclusion. Commercial performance is influenced by: (1) Medicare/managed care coverage for GLP-1s, (2) utilization management criteria (prior authorization, step therapy), and (3) the ability to maintain supply through demand spikes.

Market structure that matters

  • Diabetes population depth: The addressable base for oral semaglutide is large because type 2 diabetes remains widely undertreated to guideline targets, creating room for oral GLP-1 expansion.
  • Oral GLP-1 adoption curve: Oral delivery shifts patient preference and persistence compared with injection barriers, particularly among earlier-line patients and those refusing injections.
  • Formulary dynamics: GLP-1s compete not by mechanism alone but by formulary placement, rebate structures, and restriction rules.

What is the competitive landscape and how does it affect Rybelsus projections?

Rybelsus competes primarily with:

  • Injectable GLP-1 receptor agonists (more established dosing familiarity and broad formulary footprint).
  • Dual incretin therapies (emerging within diabetes and weight loss, with stronger weight loss and sometimes better HbA1c profiles).
  • Oral small-molecule alternatives that try to win earlier-line space through cost or convenience.

Competitive effects that directly drive Rybelsus adoption

  • Weight loss differentiation: As weight-loss indications expand market pull, products with stronger weight outcomes can capture higher-value segments even if diabetes indication is unchanged.
  • Dose convenience and adherence: Oral semaglutide’s value proposition is anchored in “no injection,” but it depends on patient adherence to administration instructions.
  • Switching economics: Payers push switching based on net price and outcomes-based contracting where available. For oral semaglutide, net pricing and rebate structures are decisive in maintaining preferred status.

The competitive environment aligns with the broader incretin-class market trends described in regulatory and market reporting for GLP-1 and related therapies (see citations [1]-[4]).


What do market analysis metrics imply for future growth of Rybelsus?

Market growth is typically modeled by:

  • Penetration of eligible diabetes patients into GLP-1 therapy
  • Share shift within GLP-1s toward oral and toward products with favorable outcomes
  • Conversion from lower-efficacy agents (DPP-4, sulfonylureas, metformin intensification)
  • Persistence and dose continuity

Base-case growth drivers

  1. Ongoing GLP-1 expansion in earlier-line treatment
  2. In-market inclusion (commercial formularies)
  3. Incremental indication value where regulators accept outcomes evidence
  4. Patient preference for oral administration

Base-case headwinds

  1. Oral adherence friction and GI tolerability limits
  2. Stronger weight-loss positioning by competitors
  3. Utilization management tightening if payers re-balance budgets

Rybelsus market projection: base, upside, and downside paths

Projection framework (used for actionable planning)

Because no single public dataset cleanly reconciles revenue-to-volume conversion across all geographies at the required granularity in a single table, projections below are presented as scenario-based adoption and revenue-direction drivers rather than a single precise numeric forecast.

Base case

  • Rybelsus maintains share in oral GLP-1 and grows in line with class expansion.
  • Growth is driven by continued formulary inclusion and patient conversion from injectables or other injectables to oral where clinically appropriate.

Upside case

  • Faster-than-expected uptake in high-risk populations if additional outcomes readouts reinforce cardiovascular and kidney risk reduction narratives.
  • Improved persistence and fewer dose interruptions from regimen refinements or better supportive care standards.

Downside case

  • Competitive share loss to dual incretin or higher-efficacy weight-loss products if payers shift coverage quickly.
  • Tighter restrictions reduce eligible patient access and slow switch rates.

Commercial KPIs to track quarterly (decision-grade)

  • New-to-brand starts and switch rate from other antidiabetes agents
  • Persistence at 3, 6, and 12 months
  • Formulary breadth (new preferred placements, restriction tightening, step-therapy adoption)
  • Net price and rebate trend (proxy via wholesaler and channel data where available)
  • Demand by dose strength (helps detect adherence and tolerability bottlenecks)
  • Safety signal monitoring (GI events and discontinuation rates are leading indicators)

What is the supply and access outlook?

Rybelsus commercial scaling depends on stable manufacturing and distribution. In GLP-1 markets, temporary access shocks typically appear as:

  • wholesaler inventory drawdowns and backorders,
  • dose-specific shortages,
  • and reallocation patterns across strengths.

The risk for Rybelsus is most acute during demand surges that outpace manufacturing ramp, which can create loss of momentum through missed adherence windows.


Patent and exclusivity considerations that shape competitive duration

For planning horizon and investment allocation, Rybelsus competitive risk is framed by:

  • compound and formulation patent fences,
  • method and use patent coverage,
  • regulatory exclusivities across key markets,
  • and biosimilar or generic threat pathways depending on product class and jurisdiction.

Generic or copycat pressure would likely be constrained by the strength and breadth of semaglutide-related IP and by regulatory requirements for demonstrating bioequivalence and safety.

Patent fence analysis requires jurisdiction-specific claim construction and expiry mapping. This response does not include a claim-by-claim expiry table because it would require a full patent family dataset and claim status verification.


Key Takeaways

  • Rybelsus is anchored by established clinical efficacy for type 2 diabetes and by the semaglutide-class outcomes evidence that supports payer adoption.
  • The next phase of growth depends less on initial efficacy and more on access: formulary placement, persistence, and tolerability-driven adherence.
  • Market projections should be scenario-based and guided by KPIs: starts, switch rate, persistence, net price trajectory, and dose-specific demand.
  • Competitive pressure from injectable GLP-1s and dual incretin therapies will likely shift share within incretin classes even if total category growth remains positive.

FAQs

1) What endpoints most influence Rybelsus payer decisions in 2026-2028?

Cardiovascular outcome evidence, kidney-related composites, durable HbA1c control, and weight-related clinical endpoints used in formulary value assessments.

2) Does Rybelsus’ oral route change how patients switch within GLP-1 therapy?

Yes. Oral administration changes the switching funnel: more patients will consider GLP-1 therapy earlier, and persistence can improve where injection aversion is a dominant barrier, subject to GI tolerability and adherence to administration requirements.

3) What is the biggest commercial execution risk for Rybelsus?

Dose-level continuity. GLP-1 markets punish missed titration steps and discontinuations, which then convert into share loss at the next refill cycle.

4) How do competitors affect Rybelsus projections without eliminating the GLP-1 category?

They reallocate preferred formulary position and net price advantage, especially when they offer superior weight loss or stronger outcomes profiles in high-risk diabetes cohorts.

5) What should investors watch to validate the base-case scenario?

Quarterly trends in brand starts, persistence at 6 and 12 months, restriction changes by payer group, and net pricing through rebate dynamics.


References

[1] European Medicines Agency. Rybelsus: EPAR and product information (oral semaglutide).
[2] U.S. Food and Drug Administration. Rybelsus (semaglutide) prescribing information.
[3] SUSTAIN trial program publications for semaglutide and regulatory outcomes reporting across clinical development.
[4] Institute for management and market reporting on GLP-1 class adoption and competitive landscape (public market analyses covering incretin therapies).

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