High Discontinuation Rates of GLP-1 Agonists in Obese Patients - EMJ

High Discontinuation Rates of GLP-1 Agonists in Patients Who Are Obese

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RECENT findings highlighted a concerning trend in the discontinuation rates of Glucagon-like peptide-1 (GLP-1) receptor agonists among patients with type 2 diabetes (T2D) and obesity. GLP-1 receptor agonists, including dulaglutide, exenatide, liraglutide, and semaglutide, are widely prescribed for their benefits in reducing cardiovascular disease risk and aiding weight loss in T2D patients. Despite these advantages, many patients discontinue their use. Prior research indicated a 12-month discontinuation rate of 45.2% among T2D patients, but the prevalence and reasons for discontinuation among those with obesity were less clear. A study presented at the 2024 European Academy of Allergy and Clinical Immunology Congress examined the prevalence of GLP-1 discontinuation amongst newly prescribed T2D and patients who are obese and the characteristics associated with discontinuation.   

Using data from the Komodo Healthcare Map database, the study examined 195,915 adults who began GLP-1 agonist treatment in 2021. Participants were required to have continuous enrolment in a commercial, Medicare, or Medicaid plan for at least 12 months before and 17 months after starting treatment. The study excluded those without T2D or obesity at baseline.  

The results showed significant discontinuation rates: 26.2% at three months, 30.8% at six months, and 36.5% at 12 months. Notably, patients with obesity alone had higher discontinuation rates at 12 months (50.3%) compared to those with T2D alone (35.8%) and those with both conditions (34.2%). Discontinuation was more common among Black or Hispanic patients, males, Medicare or Medicaid enrollees, those living in areas with high social needs, and patients with obesity, heart failure, or other cardiovascular conditions. Additionally, patients who experienced new gastrointestinal side effects or had higher out-of-pocket costs were more likely to stop taking their medication. Older patients, conversely, were less likely to discontinue. The study revealed that the average adherence, defined by the proportion of days covered, was 81.1% at three months, 72.3% at six months, and 64.3% at 12 months. This decreasing adherence over time highlights the challenges in consistently using GLP-1 agonists.  

These findings have significant policy and clinical implications, suggesting that demographic and financial factors influence medication adherence. The higher discontinuation rate among patients with obesity raises questions about whether weight loss or adverse effects drive this trend. Further research is needed to understand these dynamics and explore strategies to improve long-term adherence to GLP-1 agonist therapy, thereby enhancing patient outcomes in managing T2D and obesity. 


Do D et al. GLP-1 receptor agonist discontinuation among patients with obesity and/or type 2 diabetes. JAMA Netw Open. 2024;7(5):e2413172-. 


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