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This approval came from the SELECT trial, which demonstrated a 20% reduction in major adverse cardiovascular events with semaglutide compared to placebo

The Aib8 substitution in semaglutide creates steric hindrance that prevents DPP-4 binding, eliminating this primary clearance pathway

Step 2: The First Increase

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The molecule loses biological activity through hydrolysis, oxidation, or aggregation while the solution still looks clear