Treating class 2-3 obesity with glucagon-like peptide-1 agonists: A 2-year real-world cohort study

Despite excellent weight-loss outcomes in clinical trials, Glucagon-Like Peptide 1 receptor agonists (GLP1RA) face challenges with accessibility and compliance in clinical use. We seek to quantify how these barriers impact the long-term weight-loss efficacy of GLP1RAs in the real world.

In this retrospective cohort study, we analysed weight loss outcomes of patients who were prescribed GLP1RA for class 2-3 obesity treatment between January 2020 and November 2022 in a large non-profit healthcare system in the Midwest. The primary outcome is the two-year total weight loss percentage (TWL%).

During the study period, there was a six-fold growth in GLP1RA prescription numbers. In total, 853 patients were prescribed GLP1RA for obesity treatment. Of these, 211 (24.7%) patients never received the drug and 304 (35.6%) patients had to discontinue treatment within 2 years. The most common reasons for discontinuation included loss to follow-up with the original prescriber (n = 81, 26.6%), side effects (n = 72, 23.7%) and cessation of insurance coverage (n = 65, 21.4%). Two years later, patients who stayed on GLP1RA experienced significantly more weight loss than those who never started it (difference 3.98%, 95% CI 1.57% to 6.41%, p = 0.001) and those who had stopped taking it (difference 5.82%, 95% CI 3.56% to 8.09%, p < 0.001). Patients who stopped GLP1RA within 2 years had similar weight loss to those who never started it (difference 1.83%, 95% CI -1.30% to 4.97%, p = 0.251). The average TWL% for patients who stayed on GLP1RA for 2 years is 9.22% (standard deviation 9.73%).

Nearly half of the patients who were started on GLP1RA, a treatment intended for indefinite use, stopped taking GLP1RA within 2 years. Patients who stopped treatment experienced similar weight loss to those who never started treatment. For real-world patients who stayed on treatment for 2 years, a lower TWL% was observed than previously reported in clinical trials.