Adherence and Effectiveness of Liraglutide in Adolescents with Obesity

Background: Glucagon-like peptide-1 receptor agonists, such as liraglutide, have been approved for the management of pediatric obesity. However, real-world evidence remains limited. We aimed to evaluate real-world adherence to and effectiveness of liraglutide among adolescents with obesity. Methods: In this retrospective observational study, we included adolescents aged 12-18 years with obesity who were dispensed liraglutide through Clalit Health Services between January 28, 2022 and July 1, 2024. Adherence was defined as the number of monthly prescriptions dispensed over 12 months. Effectiveness was assessed by percent change in BMI. Multivariate logistic regression was used to evaluate factors associated with adherence (defined as ≥7 dispensed prescriptions). Linear regression was used to assess the association between the number of prescriptions dispensed and the percent change in BMI, adjusting for sociodemographic and clinical variables. Results: Of 966 adolescents (median baseline BMI 38.2), 172 (18%) were dispensed ≥7 monthly prescriptions. A total of 542 participants had follow-up BMI data. Mean BMI change for the entire cohort was -2%. Among those dispensed ≥7 prescriptions, BMI reduction was -10%. Each additional dispensed prescription was associated with a 1.1% (95% CI: -1.4% to -0.83%) reduction in BMI. In adolescents with ADHD, adherence to liraglutide was higher in those medically treated for ADHD (p < 0.001). Conclusions: Meaningful BMI reduction was observed only in adolescents dispensed ≥7 liraglutide prescriptions. However, only 18% achieved this level of adherence, underscoring the gap between randomized controlled trial efficacy and real-world outcomes, as well as the need for strategies to improve adherence.