Real-World Adherence Trajectories of GLP-1 Receptor Agonists Among Adults and Paediatric Patients With Obesity

Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are increasingly used for obesity treatment, but real-world adherence patterns, particularly among individuals without diabetes and paediatric patients, remain poorly characterised. We aimed to identify 12-month GLP-1 RA adherence trajectories among adults and paediatric patients with obesity without diabetes and to evaluate factors associated with adherence.

We conducted a retrospective cohort study using 2021-2023 MarketScan commercial claims data. Individuals aged ≥ 10 years with obesity without diabetes who initiated GLP-1 RAs were included. Adherence was measured as monthly proportion of days covered (PDC) over 12 months. Group-based trajectory modelling was conducted separately in adult and paediatric cohorts. Multivariable logistic regression was used to identify factors associated with membership in the persistent-user trajectory.

The study included 201 229 adults and 1139 paediatric patients. Five adherence trajectories were identified in each cohort. Among adults, trajectories included immediate discontinuers (19.6%), early discontinuers (23.5%), late discontinuers (20.7%), intermittent adherents (5.5%) and persistent users (30.7%), with mean annual PDC ranging from 0.10 to 0.87. Paediatric trajectory groups were more evenly distributed, with each group representing approximately 18%-22% of the cohort and persistent users comprising 20.3%. Geographic region was consistently associated with adherence, with higher odds of persistent use in the Northeast versus the South among adults (odds ratio [OR], 1.32) and paediatric patients (OR, 1.65).

Most adults and paediatric patients with obesity had suboptimal adherence to GLP-1 RA use over 12 months. Distinct adherence trajectories and consistent regional differences highlight opportunities to better understand and address barriers to long-term obesity pharmacotherapy.