Patients with Obesity Showed High Discontinuation, Low Reinitiation of GLP-1 RAs
Researchers addressed the factors leading to and the rates of discontinuation and reinitiation of GLP-1 RAs among adults with obesity.
When compared with those who had type 2 diabetes (T2D), patients with obesity were significantly more likely to discontinue and less likely to reinitiate glucagon-like peptide-1 receptor agonists (GLP-1 RAs), despite most of the population discontinuing the therapy within 1 year.
“More than 73% of US adults have obesity or overweight, incurring approximately $173 billion in associated medical costs annually,” wrote authors of the study published in JAMA Network Open.1 “Although GLP-1 RAs substantially lower weight, hemoglobin A1c levels, and cardiovascular risk, trials suggest they must be continued for sustained effects. Ongoing use of GLP-1 RAs may be limited by issues related to tolerability, efficacy, access, and cost.”
Researchers explored patients with obesity using GLP-1 RA medications liraglutide, injectable semaglutide, or tirzepatide. | image credit: alones / stock.adobe.com
The boom in GLP-1 RAs has not gone unnoticed as this class of medication increased 300% from 2020 to 2022 and 3 different types of GLP-1 RAs have been under a drug shortage since 2024.2,3 Despite having multiple indications to treat various comorbidities like cardiovascular disease and chronic kidney disease, patients using GLP-1s typically gravitate toward their weight-loss effects.
“Although most patients taking a GLP-1 RA achieve clinically meaningful weight loss, heterogeneity in response exists. In addition, most patients’ weight loss plateaus. Accordingly, a lack of desired weight loss could lead to discontinuation of GLP-1 RAs for some,” they continued.1
READ MORE: Subcutaneous Amycretin Shows Weight Loss of 9.7% for 20 Weeks
The researchers mentioned the potential barriers posed by affordability of GLP-1 RAs and patient income, which can noticeably influence access to these medications. Aside from costs, limited coverage exists for weight-loss medications and patients are using them off-label, presenting notable challenges in ensuring the safety and proper use of GLP-1 RAs.
For patients using GLP-1 RA medications liraglutide, injectable semaglutide, or tirzepatide, researchers aimed to address the key factors leading to patients’ discontinuation and subsequent reinitiation of the therapy. A total of 125,474 adult patients (mean age, 54.4 years; 65.4% women; 14.5% Black) were included in the study, with 61% having T2D and 39% without.1
Regarding participants that discontinued their GLP-1 RA therapy, 81,919 were fully off their medication within 2 years. Furthermore, 53.6% of patients discontinued within 1 year and 72.2% discontinued within 2 years. Patients with T2D discontinued GLP-1 RAs significantly less than those without. Indeed, 46.5% and 64.1% of patients with T2D discontinued within 1 year and 2 years respectively. For those without T2D, 64.8% and 84.4% discontinued a GLP-1 RA therapy within 1 year and 2 years respectively.
“Accounting for censoring, 47.3% of patients with T2D and 36.3% of patients without T2D reinitiated a GLP-1 RA within 1 year, and 57.3% with T2D and 46.4% without T2D reinitiated a GLP-1 RA within 2 years of discontinuation,” wrote authors of the study.1 These results highlight that patients with T2D reinitiated GLP-1 RAs significantly more than those without T2D.
One of the first key factors researchers explored in GLP-1 RA discontinuation and reinitiation was age. They found that patients over 65 years old were significantly more likely to discontinue their therapy and less likely to reinitiate it.
They found further associations between income and patients’ discontinuation or reinitiation, highlighting a correlation between high income and general use of GLP-1 RAs. Participants with higher annual incomes showed significantly lower rates of discontinuation. Researchers also discovered a positive correlation between high income individuals and higher reinitiation, showing that income has a similar association with discontinuation and reinitiation to that of T2D.
“The associations between weight loss and discontinuation and between weight regain and reinitiation suggest that weight management is an important factor regardless of T2D status,” they wrote.1
With the GLP-1 RA class of medication first approved to treat T2D, and then catching a boom in popularity because of its significant weight management capabilities,4 patients with either obesity or T2D are going to be key populations seeking these medications. However, with drug shortages, spikes in demand, and other market influences, access to GLP-1 RAs has proved to be challenging, leading to research like this that undermines the complexity of US health care and the pharmaceutical supply chain.
“Greater weight loss and higher income (T2D only) were associated with lower discontinuation, while weight regain since discontinuation was associated with higher reinitiation. Access to and insurance coverage of GLP-1 RAs for patients without T2D may have been associated with these differences. Inequities in access and adherence to effective treatments have the potential to exacerbate disparities in obesity,” they concluded.1
READ MORE: Obesity Management Resource Center
Pharmacy practice is always changing. Stay ahead of the curve: Sign up for our free Drug Topics newsletter and get the latest drug information, industry trends, and patient care tips, straight to your inbox.
