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In SELECT, a trial of more than 17,000 people on semaglutide, serious adverse events were actually lower than on placebo, about 33 percent versus 36 percent (Lincoff et al., 2023)
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Data were sourced from TriNetX, a network of 70 US health care organizations, using diagnostic codes to identify eligible patients while excluding those with hepatocellular carcinoma or cholangiocarcinoma

Semaglutide works through one hormonal pathway (GLP-1)

But almost all of the serious complications cluster in patients who were started at high doses and escalated aggressively
[DOI] [PMC free article] [PubMed] [Google Scholar] 5.Krieger J.P., Arnold M., Pettersen K.G., Lossel P., Langhans W., Lee S.J