New real-world study unveils key trends in GLP-1 RA discontinuation and reinitiation

A recent study by Truveta Research, in collaboration with Dr Ezekiel Emanuel from the University of Pennsylvania Perelman School of Medicine, has uncovered insights into the patterns of discontinuation and reinitiation of GLP-1 receptor agonists (GLP-1 RAs).

This research, which analyzed electronic health record (EHR) data from Truveta Data, focuses on a cohort of patients with overweight or obesity who started GLP-1 RA treatment between 2018 and 2023.

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Study overview and key findings

The retrospective cohort study, published as a preprint* in MedRxiv, analyzed the EHRs of 96,544 adults who started GLP-1 RA medications, including liraglutide, injectable semaglutide, or tirzepatide. At the initiation of treatment, the average age of participants was 55.1 years, with 65.2% being female and 73.7% identifying as white. Approximately 61.3% of these patients had type 2 diabetes (T2D). Among patients with and without T2D, nearly half and over half, respectively, had incomes exceeding $50,000 annually.

The research revealed that 46% of patients with T2D and 65% of those without T2D discontinued their GLP-1 RA treatment within 1 year. Several factors were associated with discontinuation, including weight loss, income level, gastrointestinal adverse events, and comorbidities. Specifically, greater weight loss, the absence of gastrointestinal issues, and higher income (notably among T2D patients) were linked to higher rates of discontinuation.

Following discontinuation, 51% of patients with T2D and 35% of those without T2D reinitiated GLP-1 RA therapy within a year. Weight re-gain after discontinuation was a significant factor influencing reinitiation. Of the 28,142 patients who had a recorded weight post-discontinuation, those with T2D were more likely to restart treatment compared to their non-T2D counterparts.

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Study implications

The findings underscore the complexity surrounding the adherence to GLP-1 RA treatments. Discontinuation rates are significantly higher among patients without T2D, potentially due to factors such as insurance coverage limitations and cost. Additionally, reinitiation rates highlight a direct correlation with weight gain post-discontinuation.

This study provides crucial insights into the patterns of GLP-1 RA usage and highlights the need for targeted strategies to improve adherence and accessibility. The impact of socioeconomic factors and the role of weight changes in treatment adherence are essential areas for ongoing research and policy development. Addressing these challenges may improve long-term treatment outcomes and reduce health disparities associated with obesity and diabetes.

In a blog post accompanying the publication, the authors emphasized the multifaceted nature of these trends, stating,

“Our findings suggest that discontinuation and reinitiation are multi-faceted, with a variety of potential influencing factors, including access, tolerability, and effectiveness. Unsurprisingly, our findings point to the potential importance of weight changes during initial treatment and after stopping treatment.”

*Editor’s note: The article published in MedRxiv is a preprint and has not been peer-reviewed. It reports new medical research that has yet to be evaluated and so should not be used to guide clinical practice.