In research supported by the National Cancer Institute to investigate patients’ persistence and health outcomes with GLP-1 RA medications, Hamlet Gasoyan, PhD, co-author, and colleagues from the Cleveland Clinic conducted a retrospective cohort study into factors influencing the long-term use of antiobesity medications.

Of the 3,389 subjects included in the study, 1,341 received semaglutide for T2D and 377 for obesity; 1,444, liraglutide for T2D; and 227, liraglutide for obesity. Patients’ mean [SD] age was 50.4 [12.2] years, and 1,835 [54.7%] were female. This cohort was extracted using electronic health records from a large, integrated health system in Ohio and Florida.

Participants included adults with a body mass index (calculated as the weight in kilograms divided by the height in meters squared) of no less than 30 and who had initiated treatment with semaglutide or liraglutide between July 1, 2015, and June 30, 2022. Follow-up was completed on July 28, 2023.

The FDA approvals of the GLP-1 RA medications used for weight reduction and management has been a game changer in the fight against obesity. And while the GLP-1 RA agents are also approved for the diagnosis of diabetes, the authors inform that previous research and predictive models demonstrate that individuals with diabetes experience a lower response to weight loss than those who do not have diabetes (-3.2% in mean weight change compared with -5.9% for obesity treatment).

Other factors that were observed to be associated with success of achieving at least a 10% or greater weight reduction 1 year after the initiation of the regimen included receiving semaglutide versus liraglutide and using a higher maintenance dose versus a lower maintenance dose (weight loss of -5.1% with semaglutide versus -2.2% with liraglutide and -3.5% mean weight change with low maintenance dose vs. -6.6% with high doses).

The researchers hypothesized that the less robust weight loss outcome seen in patients with diabetes involved the concomitant influence of other diabetic medications prescribed in their regimen along with other factors, such as reduced glucosuria and altered microbiota, in those individuals. The authors also speculated that diabetic patients may have struggled with obesity for longer periods and are less committed to the level of exercise that is associated with some of the weight-loss potential of GLP-1 RA agents.

According to Dr. Gasoyan, “Our findings could help inform patients and providers regarding some of the key factors that are associated with the probability of achieving sustained weight loss of a magnitude large enough to provide clinically significant health benefits,” he said. “Having real-world data could help manage expectations regarding weight reduction with GLP-1 RA medications and reinforce that persistence is key to achieve meaningful results,” Dr. Gasoyan added.

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