TOPLINE:

A real-world analysis revealed that nearly half of the individuals starting semaglutide for weight management discontinued treatment within 5 months, with discontinuation patterns persisting even after supply stabilization. Higher copayment amounts and a lower socioeconomic status emerged as significant barriers to maintaining the obesity treatment.

METHODOLOGY:

• Once-weekly subcutaneous semaglutide was approved by the FDA in 2021 for weight management using a standardized monthly dose-escalation protocol; however, real-world adherence to this regimen and the frequency of discontinuation are not well understood.
• Researchers conducted a real-world study using deidentified administrative claims data to examine dose-titration patterns and early treatment discontinuation rates among adult semaglutide users in the US.
• They analyzed 15,811 adults (77% women) who initiated semaglutide between June 2021 and December 2023 and had continuous insurance coverage for 6 months before and after initiation.
• Semaglutide use was ascertained from pharmacy claims for single-dose prefilled pens, and participants were followed up for 6 months.
• The dose-titration pattern over 5 months was analyzed, and multivariable Cox regression was used to identify factors associated with discontinuation, defined as a gap exceeding 30 days between dispensing.

TAKEAWAY:

• Within the study cohort, 69% initiated the recommended 0.25 mg dose, and 57% achieved maintenance doses during follow-up — 22% achieved 1.7 mg and 34% achieved 2.4 mg.
• The cumulative discontinuation rate was 46% by the fifth month after initiation and remained at 48% even after supply was restored in October 2023, suggesting factors beyond availability contribute to discontinuation.
• Higher copayment amounts showed a dose-dependent association with discontinuation; people in the highest copay bracket ($161-$1460) were 33% more likely to quit than those in the lowest copay bracket ($1-$54).
• Discontinuation was also more likely among users aged 18-29 years or 65 years or older, those with a high school education or less, and those from households with annual incomes of $75,000 or less.

IN PRACTICE:

“These findings underscore the need for strategies to support long-term treatment adherence in routine clinical practice,” the authors wrote.

SOURCE:

This study was led by Yunwen Xu, Johns Hopkins Bloomberg School of Public Health, Baltimore. It was published online in Obesity.

LIMITATIONS:

This study was restricted to prescriptions under the brand name Wegovy and did not consider transitions to alternative GLP-1 receptor agonist formulations. It lacked information on BMI and was unable to identify reasons for discontinuation or evaluate the clinical appropriateness of the observed patterns. Moreover, the analysis could not account for manufacturer-sponsored drug coupon use and failed to capture prescriptions paid entirely out of pocket.

DISCLOSURES:

This study was supported by the National Institute of Diabetes and Digestive and Kidney Diseases of the National Institutes of Health. The authors declared having no conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.