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The theory is that combining pharmaceutical appetite suppression with ketosis-driven metabolic changes might overcome a plateau

ROS are highly reactive, unstable molecules our bodies produce during normal metabolism and in response to environmental stresses

At the same time 32% of those studied experienced adverse events, including liver dysfunction and one case of anaphylaxis (Alzahrani et al., Cureus 2025, PMID 40013212)

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Day 61 or thereafter if : If no additional glycemic control is needed, then maintain the dosage at 4 mg orally once daily

The SUSTAIN-7 trial directly compared dulaglutide with semaglutide, showing differences in gastrointestinal tolerability