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The appetite-suppressive effects create a secondary concern: patients taking both drugs may inadvertently restrict calories to unsafe levels, leading to nutrient deficiencies, muscle loss, or metabolic adaptation that undermines long-term weight loss
Tirzepatide, another GLP-1 option, was not included because it became available after the study began
The activity half-life in rat of exendin-4 in fusion with a carrier antibody has been previously reported as 10.8 h 26 , which is similar to the 11.5 h value we observed in mice for exendin-4 in fusion with the anti-PCSK9 Ab#2 antibody (Supplementary Table 4)
Its worth noting that occasional supply chain issues may make Rybelsus hard to get
Some institutions now recommend withholding GLP-1RAs for 12 weeks before elective procedures, particularly if the patient is early in treatment or shows symptoms of gastroparesis
