Key takeaways:
- Adults who discontinued their weight problems medicine after lower than 1 12 months misplaced 3.6% of their physique weight.
- Persevering with weight problems remedy was tied to greater than 4 occasions larger odds of 10% or higher weight reduction.
Adults with weight problems have been extra more likely to obtain a ten% or higher weight reduction at 1 12 months in the event that they continued utilizing their prescribed weight problems medicine, in accordance with findings revealed in Weight problems.
Researchers from Cleveland Clinic analyzed digital well being file knowledge to determine adults with chubby or weight problems who used semaglutide (Ozempic/Wegovy, Novo Nordisk) or tirzepatide (Mounjaro/Zepbound, Eli Lilly) from 2021 to 2024. Adults who remained on their prescribed drug for your complete size of follow-up misplaced considerably extra weight at 1 12 months than those that discontinued their medicine.
Knowledge have been derived from Gasoyan H, et al. Weight problems. 2025;doi:10.1002/oby.24331.
Hamlet Gasoyan, PhD, well being companies researcher within the division of inside drugs and geriatrics and investigator on the Heart for Worth-Primarily based Care Analysis at Cleveland Clinic and assistant professor of medication at Cleveland Clinic Lerner Faculty of Medication of Case Western Reserve College, mentioned weight reduction noticed within the research was decrease than what has been reported in trials for each semaglutide and tirzepatide. He cited discontinuation charges and the usage of decrease upkeep doses in real-world settings as two contributing elements.
Hamlet Gasoyan
“It’s essential to have discussions about persisting with remedy and having the ability to get to larger upkeep dosages if one needs to realize the weight reductions which are marketed on social media or fashionable media,” Gasoyan instructed Healio. “What we’ve seen in a real-world setting is those that discontinue notably early and sufferers who keep on decrease upkeep dosages are fairly unlikely to see the burden reductions which are reported in randomized trials. I really feel like this can inform the discussions on the very onset of selecting a remedy.”
Gasoyan and colleagues performed a retrospective cohort research of adults aged 18 years or older with weight problems from Cleveland Clinic in Ohio and Florida who began utilizing subcutaneous semaglutide or tirzepatide from 2021 to 2023. Discontinuation of weight problems pharmacotherapy was outlined as a spot of greater than 90 days between the tip of the earlier provide of the drug and the subsequent prescription dispense. The first final result was share change in physique weight from drug initiation to 1 12 months. Change in HbA1c from baseline to 1 12 months was a second major final result for adults with prediabetes at baseline.
There have been 7,881 adults included within the research (imply age, 51.3 years; 75.2% ladies), of whom 6,109 have been prescribed semaglutide and 1,772 have been prescribed tirzepatide. Of the semaglutide group, 21.6% discontinued the medicine inside the first 3 months of receiving it, 31.4% discontinued it between 3 months and 1 12 months of their preliminary prescription fill, and 47% continued the medicine by means of the tip of 2024. Of adults prescribed tirzepatide, 16.4% discontinued the medicine inside 3 months, 34.1% discontinued use at between 3 months and 1 12 months and 49.4% continued receiving the drug on the finish of follow-up.
Weight discount
Amongst 6,477 adults with weight out there at 1 12 months, imply weight reduction was 8.7%. Adults who discontinued their medicine inside the first 3 months misplaced 3.6% of physique weight at 1 12 months, whereas those that discontinued pharmacotherapy at 3 months to 1 12 months achieved a 6.8% weight reduction. Adults who didn’t discontinue remedy misplaced a imply 11.9% of their physique weight (P < .001).
Adults taking semaglutide misplaced a imply 7.7% of their physique weight at 1 12 months. Those that continued use of the drug for at 1 12 months misplaced 10.9% of their weight. Amongst those that didn’t discontinue semaglutide and have been on a excessive upkeep dose, imply weight reduction was 14.7% at 1 12 months.
The tirzepatide group misplaced a imply 12.4% physique weight at 1 12 months. Weight reduction was 15.3% for adults persevering with tirzepatide at 1 12 months. Those that didn’t discontinue tirzepatide and have been on a excessive upkeep dose misplaced a imply 18% of their physique weight.
(aOR = 1.74; 95% CI, 1.45-2.08) vs. discontinuing use inside the first 3 months. The probability of reaching 10% or higher weight reduction was additionally larger for adults prescribed tirzepatide vs. semaglutide (aOR = 2.46; 95% CI, 2.16-2.8), these receiving a excessive dose of a drug vs. a low dose (aOR = 2.39; 95% CI, 2.08-2.75) and for ladies vs. males (aOR = 1.86; 95% CI, 1.62-2.13).
HbA1c change
There have been 895 adults with prediabetes at baseline and HbA1c measurements out there at 1 12 months. Imply HbA1c lower at 1 12 months was 0.3 share factors throughout all contributors. Those that didn’t discontinue remedy achieved a 0.4 share level drop in HbA1c vs. a 0.2 share level lower for adults who discontinued remedy at 3 months to 1 12 months and a 0.1 share level drop for many who discontinued remedy inside the first 3 months (P < .001). Imply HbA1c discount was 0.4 share factors with tirzepatide and 0.3 share factors with semaglutide at 1 12 months.
Of adults with prediabetes, 53.9% achieved normoglycemia at 1 12 months. The proportion of those that achieved normoglycemia was 67.9% for adults who continued weight problems pharmacotherapy, 41% for adults discontinuing remedy between 3 months and 1 12 months, and 33.1% for adults discontinuing remedy inside the first 3 months. Kind 2 diabetes was recognized in 3.4% of the group. The proportion of adults who developed kind 2 diabetes was 6.5% amongst adults who discontinued remedy in lower than 3 months and 4.4% for these discontinuing their medicine at 3 months to 1 12 months vs. 1.7% for adults who continued utilizing their drug by means of the tip of follow-up (P < .001).
Future analysis
Gasoyan mentioned researchers are conducting one other research that may look at the the explanation why individuals discontinued their medicine.
“This physique of analysis will actually assist present insights on what ought to go right into a dialog between the supplier and affected person when it comes to the challenges with these extremely efficient medicines,” Gasoyan mentioned of future analysis. “When a choice is to be made on whether or not somebody ought to get began on [medication] or not, so I really feel like this [study] can be very useful regarding these discussions.”
“We’re constructing proof that hopefully might be constructed into prediction fashions to assist sufferers estimate, based mostly on their particular person circumstances, what’s the more than likely vary of weight discount — given their persistence, BMI, intercourse, medicine they’re about to begin — on the time of decision-making on which GLP-1 medicine to decide on, or whether or not to decide on pharmacotherapy or one other modality for the remedy of weight problems,” Gasoyan mentioned.
For extra data:
Hamlet Gasoyan, PhD, might be reached at gasoyah@ccf.org.
Perspective
Actual-world research on GLP-1s might be very deceptive as a result of it’s exhausting to confirm if sufferers really stuffed their prescriptions. There are a lot of the explanation why a affected person may get a GLP-1 prescription however by no means fill it. The most typical is that medical insurance coverage is not going to cowl the medicine. One other challenge with the GLP-1s for weight reduction is that sufferers should purchase the medicine straight from the pharmaceutical firm. The great thing about this research was the usage of an outdoor vendor to verify that the prescription was stuffed. This included prescriptions paid for by means of insurance coverage advantages, money, coupons or different strategies.
The numbers that Gasoyan and colleagues report concerning weight reduction in sufferers who discontinue early in lower than 3 months, late discontinuation between 3 to 12 months, and people who keep on the medicine for 12 months — 3.6%, 6.8% and 11.9%, respectively — are very plausible and mirror what most clinicians can count on. The modifications in HbA1c on this nondiabetic group are additionally what well being care professionals will observe in follow.
The ultimate takeaway from this research is that, whatever the cause, about 20% of sufferers will cease their medicine inside 3 months of beginning. An extra 32% will cease between 3 and 12 months, and roughly 50% will proceed for at the least 12 months.
Ken Fujioka, MD
Disclosures: Fujioka stories consulting and talking for Eli Lilly and Novo Nordisk.
Sources/Disclosures
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Disclosures:
Gasoyan stories no related monetary disclosures. Please see the research for all different authors’ related monetary disclosures.
