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This mechanistic overlap explains why combining them may not produce additive benefitsthe GLP-1 receptor agonist effect of Rybelsus is already maximal, and adding a DPP-4 inhibitor to preserve endogenous GLP-1 (which is already being mimicked by semaglutide) offers limited additional advantage

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Relative expression levels of mGIPR and mGLP1R were scored on a scale of 0-4 based on ACD scoring criteria, where level 2 indicates 4-9 dots/cell, no or very few dot clusters

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