medwireNews: Only a third of people given a glucagon-like peptide (GLP)-1 receptor agonist in clinical practice lose a clinically meaningful amount of weight, potentially due to high rates of discontinuation, say researchers.
Tracey Weiss (Merck & Co, Inc, Kenilworth, New Jersey, USA) and study co-authors used the UK’s Clinical Practice Research Datalink to identify 589 people who were newly prescribed a GLP-1 receptor agonist, either as monotherapy or in combination with metformin. The study participants were an average of 53.0 years old, 56.4% were women, and their average BMI was 41.7 kg/m2.
Just over half (57.9%) of these people had weight measurements at 12 months after the first prescription, by which time 33.4% had lost at least 5% of their starting bodyweight. However, 29.0% gained weight.
After 24 months, 39.4% of the cohort had weight measurements available, at which time 43.5% had lost at least 5% of their bodyweight but 32.3% had gained weight.
“This finding suggests that, compared with trials, patients in the real world may not frequently achieve clinically meaningful weight loss,” write the researchers in BMJ Open Diabetes Research & Care.
“It may also suggest that lifestyle interventions, including diet, physical exercise, and psychological support, remain an important component of a weight management strategy in patients with [type 2 diabetes] as pharmacological therapy alone is unlikely to help the majority of patients achieve clinically meaningful weight loss.”
However, the team stresses that the real-world rate of discontinuation was “substantially higher” than that reported in clinical trials, with 45.2% of the cohort discontinuing within 12 months and 64.7% at 24 months.
Surprisingly, the discontinuation rate was slightly higher for weekly than daily GLP-1 receptor agonists, at 54.8% and 42.6%, respectively. Weiss and colleagues say this is contrary to results in other real-world studies.
At 12 months, 64.5% of the study participants who had not discontinued were still obtaining sufficient medication to cover at least 80% of days’ use, and, contrary to the pattern of discontinuation, this was more likely for those taking a weekly rather than daily GLP-1 receptor agonist, at 82.1% versus 59.8%. At 24 months these rates fell to 59.2% overall, 74.1% for weekly injections, and 55.3% for daily dosing.
“The high rates of discontinuation observed in this study prompt consideration of the real-world impact of GLP-1 [receptor agonists] on outcomes,” say the researchers.
They add: “The findings of the present study suggest that outside the context of randomized trials, patients prescribed GLP-1 [receptor agonists] discontinue therapy sooner which may impact GLP-1 [receptor agonists’] effectiveness in the real world.”
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