The research was done in patients participating in a weight-loss program who were tapered off the medication when they reached their target weight. The study was led by researchers at Embla, a digital weight-loss clinic based in both Copenhagen, Denmark, and London, United Kingdom.
The study found that lower doses were just as effective as higher doses and that slowly reducing medication, while focusing on lifestyle changes, prevents weight regain.
The researchers said that the objective of their investigation was to explore the impact of dose tapering of semaglutide for patients with obesity as clinically relevant weight loss is achieved.
“A total of 54 participants tapered semaglutide to zero and did so on average 9.9 weeks (95% CI, 7.6 to 12.2) after the dose tapering was planned and initiated,” according to the report. “The average change in body weight was -0.5% (95% CI, –1.7 to 0.6 %) from cessation to last available data point (31st of December 2023).”
The study team noted that eight participants reinitiated dosing of semaglutide, adding that 10 weeks post cessation, there was a 19.5% (95% CI, 5.6%-31.3) probability of restarting semaglutide.
The real-world cohort study involved 2,246 Danish participants, which were mostly female (79%). The participants had a median age of 49 years, a median BMI of 33.2, and median body weight of 97 kg. All were enrolled in a weight-management program run through the Embla application, available in Denmark and the UK.
In addition to advice from a nutritionist on healthy eating, increasing exercise and overcoming the psychological barriers to weight loss, users of the application had access to doctors, nurses, psychologists, and a course of a weight-loss drug semaglutide (Ozempic or Wegovy).
The standard dosing schedule, in which a low initial dose of semaglutide (0.25 mg once weekly for Ozempic and Wegovy), is increased every 4 weeks for 16 weeks to a maximum dose of 2 mg for Ozempic and 2.4 mg for Wegovy. Dosage was tailored to individual patients to minimize side effects.
The patients stayed on a dose if they maintained a weekly weight reduction >0.5% of their body weight and experienced manageable levels of side effects and hunger. The average maximum dose of semaglutide was 0.77 mg.
After 26, 64, and 76 weeks, 1,392, 359, and 185 patients, respectively, were still taking part in the program, with an average weight loss of 14.8% (14.8 kg) at Week 64 and 14.9% (14.9 kg) at Week 76.
During the program, the patients used about one-third of the amount of semaglutide that is prescribed on the standard treatment schedule—36.1% of the suggested cumulative dose at Week 64 and 34.3% at Week 76).
“Our results show that weight loss is achievable regardless of initial BMI and the amount of semaglutide used,” explained Henrik Gudbergsen, MD, PhD, the lead researcher and Embla’s CMO. “Using lower doses of semaglutide is cheaper for patients, results in fewer side-effects and helps ensure that stocks of the drug, which are still limited, go further.”
The researchers concluded that patients who tapered off semaglutide maintained a stable body weight for the first 26 weeks.
“The combination of support in making lifestyle changes and tapering seems to allow patients to avoid regaining weight after coming off semaglutide,” Dr. Gudbergsen pointed out. “A patient’s appetite returns when they stop taking the drug and if they stop taking it suddenly, they may find it hard to resist their cravings. However, if they stop slowly, and have expanded their awareness and understanding of healthy lifestyle behaviors and eating habits, their hunger and satiety will be more manageable, making it easier for them to maintain a healthy weight.”
Dr. Gudbergsen suggested that the lower maximum dose “creates a bigger need for patients to engage whole-heartedly in supportive lifestyle changes throughout the program, which should help with losing weight and with keeping it off.”
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