Weight Loss Injections Part 4: Victoza® & Saxenda® (Liraglutide)

Victoza® and Saxenda® (liraglutide) are the same medication and are once-daily self-administered injections in single-use, disposable pens.

Their differences include the following:

Victoza®

The FDA first approved Victoza® in January 2010 for adults with type 2 diabetes, then again in June 2019 for children (ten years and older) with type 2 diabetes.

It is prescribed to reduce an individual’s blood sugar and manage their HbA1C.

The dosing schedule includes three dosages ranging from 0.6 mg/3 ml to 1.8 mg/3 ml.

Please view the brand’s “Medication Guide” for more extensive information regarding patient use.

Saxenda®

Saxenda® was first FDA-approved in December 2014 as a weight management medication for adults with the following:

• Obesity (BMI>30)
• A BMI>27 with weight-related health complications

In December 2020, the medication was approved for teens 12 to 17 years with a body weight >132 lbs.

The dosing schedule includes five dosages ranging from 0.6 mg/3 ml to 3.0 mg/3 ml.

Please view the brand’s “Medication Guide” for more extensive information regarding patient use.

Liraglutide

Liraglutide (Victoza®) is the first once-daily GLP-1 receptor agonist injection for type 2 diabetes management.

*Links to the rest of this series are available at the bottom of this page.

While semaglutide and liraglutide are both GLP-1 receptor agonists, the modification of GLP-1 in semaglutide increases its half-life. The longer half-life makes semaglutide a once-weekly injection.

Liraglutide has a shorter half-life than semaglutide, making it a once-daily injection to maintain the benefits associated with GLP-1 receptor agonist medications.

Liraglutide & Type 2 Diabetes

B Juhl et al. concluded that liraglutide reduces fasting and meal-related blood sugar levels by:

• Delaying gastric emptying,
• Increasing insulin secretion,
• And limiting blood sugar levels.

Liraglutide & Type 2 Diabetes: Effects on Adults

The 2009 “Liraglutide Effects and Action in Diabetes” (LEAD™) trial is comprised of multiple (a total of six) phase-three trials.

Each phase-three trial observed the safety and efficacy of liraglutide as a monotherapy and in conjunction with other medications for type 2 diabetes management. In this instance, we’ll focus on the LEAD-3 Mono trial regarding liraglutide as a monotherapy.

Trial Characteristics:

• Trial Length: 52 weeks

• Two Liraglutide Groups:
• 2 mg once daily
• 8 mg once daily

• Baseline HbA1C Average:2%

At the end of the 52 weeks, the average decrease in the HbA1C levels for each liraglutide group is as follows:

• 2 mg once daily: -0.84%
• 8 mg once daily: -1.14%

This trial concluded that liraglutide as a monotherapy is safe and effective for type 2 diabetes management and reduces HbA1C, weight, hypoglycemia, and blood pressure.

Liraglutide & Type 2 Diabetes: Effects on Adolescents

A phase 3 trial studied the efficacy of liraglutide compared to a placebo in adolescents (ages 10-16) with type 2 diabetes.

The primary efficacy endpoint was the changes in the average HbA1C levels from the start of the trial to 26 weeks of treatment.

Researchers placed patients in one of three liraglutide groups (0.6 mg, 1.2 mg, and 1.8 mg) or the placebo group. The baseline HbA1C level average was 7.78%.

Statistically significant measurements at 26 weeks regarding treatment efficacy:

• The average HbA1C difference for the liraglutide and placebo patients at 26 weeks.
• The percentage of liraglutide and placebo patients with an HbA1C level below 7% at 26 weeks.

Results at 26 weeks:

• Liraglutide Groups:
• Average HbA1C Difference: -0.64
• HbA1C level <7%:7%

• Placebo group:
• Average HbA1C Level: +0.42
• HbA1C level <7%:5%

For more detailed information and graphics on this trial, please view its “Supplementary Appendix.”

Researchers concluded that liraglutide with metformin was superior to placebo and metformin regarding glycemic control.

Liraglutide & Weight Loss

Astrup et al. observed the effects of liraglutide 3.0 mg once daily versus placebo on weight management over 56 weeks.

The baseline body weight average was 234.1 lbs.

The measurements researchers took at 56 weeks included the following:

• Average weight loss for the liraglutide and placebo groups.
• The percentage of liraglutide and placebo patients who lost more than 5% and 10% of their body weight.

• Liraglutide Group
• Average Weight Loss: -18.5 lbs
• >5% Weight Loss:2%
• >10% Weight Loss:1%

• Placebo Group
• Average Weight Loss: -6.2 lbs
• >5% Weight Loss: 1%
• >10% Weight Loss: 6%

No substantial research suggests significant differences in liraglutide’s weight loss efficacy in adults and adolescents.

Side Effects

The most common semaglutide side effects are gastrointestinal:

• Nausea
• Vomiting
• Diarrhea
• Constipation
• Abdominal Pain
• Heartburn

These side effects can range from mild to severe. Patients should contact their doctor if the side effect(s) is severe or doesn’t go away.

Serious side effects:

• Thyroid Tumors
• New or Worsening Depression
• Allergic Reaction
• Gallbladder Disease:
• Cholelithiasis (gallstones)
• And cholecystitis
• Pancreatitis
• Hypoglycemia
• Decreased Urination
• Fainting
• Dizziness
• Upper Stomach Pain; Fever; Yellowing Skin or Eyes; Fever; Clay-Colored Stool (Liver Damage)

Additional side effects:

• Headache
• Decreased Appetite
• Runny nose, sneezing, or cough
• Tiredness
• Difficulty urinating
• Urination: Pain or Burning
• Injection Site: Rash or Redness

Please follow the links for the Victoza® and Saxenda® Medication Guides (available at the top of the blog) for more information specific to the brands.

Weight Loss Injections: A Summary

Based on available studies and trials, the most effective subcutaneous drug class/medication for treating type 2 diabetes and obesity in descending order are:

1. Mounjaro® (tirzepatide)
2. Ozempic®/Wegovy® (semaglutide)
3. Victoza®/Saxenda® (liraglutide)

General Pros & Cons

Pros:

• Induces more weight loss by:
• Adjusting insulin responses,
• Delaying gastric emptying,
• And possibly affecting neurological reactions to food.
• Urges patients to commit to beneficial nutritional and lifestyle changes.

Cons:

• Individuals may need long-term treatment to maintain how the body and brain react to food.
• Clinical studies on the long-term effects of treatment with these medications are limited.
• The type and severity of the medications’ adverse effects vary by patient. Some patients may react poorly, while others may experience success.

Some researchers have begun to study the effects of combining these medications with a post-bariatric surgery weight loss plan.

Bariatric Pros & Cons

Pros:

• These medications could be excellent for non-responder bariatric patients or those losing less weight than expected, as they would reduce the chances of revision surgery.

Associated surgical risks include the following:

• Adverse anesthetic reactions,
• Bleeding,
• Blood clots,
• And infection.

Cons:

• There are limited clinical studies on how these medications affect patients that have had bariatric surgery. Questions that still need concrete clarification include:
• How do these medications interact with bariatric surgery, and what does that mean for the patient?
• What are the effects of long-term use on a patient’s altered GI (gastrointestinal) tract due to bariatric surgery?
• How does the body respond if a patient with bariatric surgery vs. a patient without bariatric surgery must stop treatment?

Our “Weight Loss Injections” Series Contributor

ProCare Health would like to recognize award-winning Dietitian and Nutritionist Katie Chapmon as a contributor to this comprehensive series on the various medications bariatric patients may want to discuss with their doctors.

With over ten years of hands-on clinical experience in bariatric surgery and weight management, Chapmon’s wealth of educational and reliable information is valuable for the patients that use our resources to navigate pre-and post-bariatric surgery life.

ProCare Health’s “Weight Loss Injections” Series

Only two medications are FDA-approved for weight management (Wegovy® and Saxenda®).

However, the FDA granted fast-track designation for Mounjaro® with expectations that the drug will be FDA-approved for weight management later this year.

We’re sure you have many questions about these medications. If your interest is piqued, we urge you to discuss these medications with your doctor to see if any would be a good fit.

To view the other blogs in this series, you may use the following links:

• Weight Loss Injections Part 1: An Overview
• Weight Loss Injections Part 2: Mounjaro® (Tirzepatide)
• Weight Loss Injections Part 3: Ozempic®/Wegovy® (Semaglutide)

For more informational bariatric resources and premium bariatric vitamins and supplements, please visit procarenow.com.