Prescribing Patterns and Adverse Effects of Semaglutide: A Real-World Comparative Evaluation

Background: Semaglutide is a Glucagon-like peptide-1 receptor agonist (GLP-1RA) used in the treatment of type 2 diabetes mellitus (T2DM) and weight management. While its clinical benefits are well established, concerns have emerged over off-label use, underreporting of adverse drug reactions (ADRs), and prescribing disparities. Aims: To examine real-world prescribing pattern treatment efficacy and ADRs associated with semaglutide in a socioeconomically deprived United Kingdom (UK) locality, and to compare these with national data. Methods: A retrospective service evaluation was conducted using anonymised data from 1403 patients across 42 GP practices under a data share agreement across a place-based group of practices in the West Midlands. National prescribing data were obtained from OpenPrescribing, and ADR data from the Medicines and Healthcare products Regulatory Agency (MHRA) Yellow Card Scheme (01/2020-12/2024). Analyses included demographic trends, treatment efficacy (HbA1c and weight), and socioeconomic comparisons using the Socioeconomic Index for Small Areas (SEISA) deciles. Findings: Semaglutide prescribing in the GP surgeries studied peaked in 2022 and declined thereafter, mirroring national trends. Prescribing of semaglutide mirrored the ethnic make-up of the region studied with a notable exception of White British. Mean HbA1c fell by 10.8 mmol/mol and weight by 4.8%. ADR incidence in the population studied (1.85%) exceeded national reporting rates (0.20%). Prescribing was highest in practices serving the most deprived communities. Conclusions: Semaglutide is effective in reducing HbA1c and weight in real-world settings. However, ADRs remain underreported. Socioeconomic deprivation was strongly associated with higher prescribing rates. Greater attention to equitable access and pharmacovigilance is warranted.