{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T14:10:28Z","timestamp":1790259028902,"version":"4.1.0"},"reference-count":27,"publisher":"BMJ","issue":"9","license":[{"start":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T00:00:00Z","timestamp":1790208000000},"content-version":"unspecified","delay-in-days":23,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"The Philip Bushell Foundation","award":["G223181"],"award-info":[{"award-number":["G223181"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2026,9,14]]},"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>Pharmaceuticals are a major contributor to healthcare\u2019s greenhouse gas emissions yet product-level carbon footprints are rarely disclosed. Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are increasingly being used for the management of type 2 diabetes and people living with obesity, but their carbon impact remains poorly characterised. We aimed to compare carbon footprint estimates for oral semaglutide (Rybelsus), a peptide-based medicine, generated using the medicine carbon footprint (MCF) framework and manufacturer-reported life cycle assessment (LCA) data.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design and setting<\/jats:title>\n                    <jats:p>Comparative methodological analysis using cradle-to-gate boundaries to compare pharmaceutical carbon footprint estimates for oral semaglutide.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Per-tablet MCF estimates for 3, 7 and 14 mg Rybelsus were annualised and compared with product-specific LCA results reported by Novo Nordisk. Differences between methods were assessed descriptively across the three dose strengths. Absolute differences and symmetric percentage differences were calculated.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Annualised MCF estimates were 8.9, 20.0 and 39.3 kg CO\u2082e\/year for 3, 7 and 14 mg tablets, respectively. Corresponding EU LCA estimates were 17.0, 25.2 and 39.9 kgCO\u2082e\/year. The mean symmetric percentage difference was \u221229%, with the largest discrepancy observed at the 3 mg dose (\u221262.6%) and the smallest difference at the 14 mg dose (\u22121.5%).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>For oral semaglutide, MCF generated lower carbon footprint estimates than manufacturer-reported LCA values, particularly at lower doses, where fixed device\/excipient and packaging emissions are proportionally larger. MCF offers a rapid, accessible and indicative estimation method when proprietary data are unavailable. Improved transparency and harmonised boundaries would strengthen comparability between pharmaceutical carbon footprint estimation approaches. These findings are specific to the Rybelsus formulation of oral semaglutide and may not be generalisable to other formulations or GLP-1 RAs.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2026-124968","type":"journal-article","created":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T13:50:49Z","timestamp":1790257849000},"page":"e124968","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Estimating the carbon footprint of oral semaglutide (Rybelsus): a comparative analysis of the medicine carbon footprint model and manufacturer life-cycle assessment in pharmaceutical production"],"prefix":"10.1136","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1810-9357","authenticated-orcid":false,"given":"Louise","family":"Hansell","sequence":"first","affiliation":[{"name":"Central Clinical School, The University of Sydney, Sydney, New South Wales, Australia"},{"name":"Physiotherapy Department, Royal North Shore Hospital, St Leonards, New South Wales, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wandi","family":"Zhu","sequence":"additional","affiliation":[{"name":"Sydney Environment Institute, The University of Sydney, Sydney, New South Wales, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michelle","family":"Lynch","sequence":"additional","affiliation":[{"name":"Central Clinical School, The University of Sydney, Sydney, New South Wales, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"SL","family":"Hocking","sequence":"additional","affiliation":[{"name":"Charles Perkins Centre, University of Sydney, Sydney, New South Wales, Australia"},{"name":"Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David S","family":"Celermajer","sequence":"additional","affiliation":[{"name":"Central Clinical School, The University of Sydney, Sydney, New South Wales, Australia"},{"name":"Department of Cardiology, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia"},{"name":"Heart Research Institute Ltd, Newtown, New South Wales, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fabian","family":"Sack","sequence":"additional","affiliation":[{"name":"Sydney Environment Institute, The University of Sydney, Sydney, New South Wales, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,9,24]]},"reference":[{"key":"2026092406502998000_16.9.e124968.1","doi-asserted-by":"publisher","DOI":"10.1016\/S2542-5196(20)30121-2"},{"key":"2026092406502998000_16.9.e124968.2","doi-asserted-by":"publisher","DOI":"10.1088\/1748-9326\/ab19e1"},{"key":"2026092406502998000_16.9.e124968.3","doi-asserted-by":"publisher","DOI":"10.1111\/jan.15671"},{"key":"2026092406502998000_16.9.e124968.4","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(22)01540-9"},{"key":"2026092406502998000_16.9.e124968.5","doi-asserted-by":"crossref","first-page":"e196","DOI":"10.1016\/S2542-5196(25)00028-2","article-title":"The greenhouse gas emissions of pharmaceutical consumption and production: an input-output analysis over time and across global supply chains","volume":"9","author":"Hagenaars","year":"2025","journal-title":"Lancet Planet 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Annual report 2025 [annual report]. Bagsv\u00e6rd, Denmark: Novo Nordisk A\/S; 2026. 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Spoiler: Not for the reasons you are being told\u2026","volume":"30","author":"Torreele","year":"2024","journal-title":"Eur J Gen Pract"},{"key":"2026092406502998000_16.9.e124968.19","unstructured":"Novo Nordisk A\/S . Annual treatment with rybelsus\u00ae. Bagsv\u00e6rd, Denmark; 2025. Available: https:\/\/www.novonordisk.com\/content\/dam\/nncorp\/global\/en\/sustainable-business\/pdfs\/esg-portal\/lca\/2025-annual-treatment-with-rybelsus.pdf"},{"key":"2026092406502998000_16.9.e124968.20","unstructured":"U.S. Food and Drug Administration . Product quality review(s): NDA 213051 and NDA 213182 \u2013 rybelsus (semaglutide) tablets. 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