GLP-1RAs were approved for type 2 diabetes (T2D) in 2005 and for weight management in 2014. “Interest in these drugs has surged, spurred partly by the approval of semaglutide for weight management in 2021,” University of Michigan Department of Pediatrics researchers and colleagues wrote in the Journal of the American Medical Association.
“Assessing GLP-1RA dispensing to adolescents (aged 12-17 years) and young adults (aged 18-25 years) is important given the absence of data regarding the health effects of long-term use and the long-time horizon over which costs of GLP-1RA use could accrue,” the researchers added in the letter.
This study assessed GLP-1RA dispensing nationally during 2020-2023 to adolescents and young adults.
The study team obtained data on the dispensing of GLP-1RAs and drugs other than GLP-1RAs between January 2020 and December 2023 from the IQVIA Longitudinal Prescription Database, which reports prescriptions from 93.6% of U.S. retail pharmacies.
GLP-1RAs included dulaglutide, exenatide, liraglutide, semaglutide, and tirzepatide; the first three are approved for T2D in adolescents, and all are approved for that indication in adults. Liraglutide and semaglutide are approved for weight management in both adolescents and adults, while tirzepatide is only approved for that indication in adults, according to the report.
Semaglutide formulations include injectable and oral medications for T2D (Ozempic and Rybelsus) and an injectable medication for weight management (Wegovy).
The results indicated that between 2020 and 2023, the number of adolescents and young adults with GLP-1RA dispensing jumped from 8,722 to 60,567—a 594.4% increase. As a comparison, the study found that the number with dispensing of drugs other than GLP-1RAs decreased from about 12.7 million to about 12.3 million—a decrease of 3.1%.
The articles reported that the number of male adolescents with GLP-1RA dispensing increased from 692 to 4,178 (a 503.8% increase), while the number of female adolescents increased from 961 to 6,607 (a 587.5% increase). At the same time, the number of male young adults with GLP-1RA dispensing increased from 2,180 to 12,667 (a 481.1% increase), and the number of female young adults increased from 4,886 to 37,111 (a 659.4% increase).
“Among adolescents, the number who were dispensed dulaglutide, exenatide, or liraglutide was greatest throughout the period and increased steadily,” the authors pointed out. “The number who were dispensed injectable semaglutide approved for weight management increased sharply in 2023. Among young adults, the number who were dispensed dulaglutide, exenatide, or liraglutide was greatest in 2020 and 2021, but was surpassed by the number who were dispensed injectable semaglutide for type 2 diabetes in 2022 and 2023. The number who were dispensed tirzepatide increased sharply in 2022, and the number who were dispensed injectable semaglutide for weight management increased sharply in 2023.”
In 2023, a patients dispensed a GLP-1RA was more likely to be female (60%) in 2023, and to live in the South (45.7%), with similar results among young adults—76.4% were likely to be female and 46.3% from the South.
“In both age groups, the last dispensed prescription in 2023 was most commonly for injectable semaglutide for type 2 diabetes,” the study advised.
For adolescents, the payer type was most often Medicaid (48.0%), and prescribers were most commonly endocrinologists (32.7%) and nurse practitioners (26.4%). The situation was somewhat different for young adults who most often used commercial insurance (66.8%) and received prescriptions from nurse practitioners (33.0%) and family medicine physicians (22.9%).
“Increases in GLP-1RA dispensing were greatest for females, highlighting the importance of educating patients and prescribers on sex-specific safety risks (eg, concerns during pregnancy),” the authors emphasized. “Efforts to promote safe and appropriate prescribing should include endocrinologists, family medicine physicians, and nurse practitioners given their prominent roles in GLP-1RA dispensing.”
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