Cleveland Clinic Study Identifies Key Factors Influencing Long-Term Weight Loss with GLP-1 RA Medications
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A Cleveland Clinic study identified key factors that can impact the long-term weight loss of patients with obesity who were prescribed injectable semaglutide or liraglutide (glucagon-like peptide-1 receptor agonists, or GLP-1 RA medications) for the treatment of type 2 diabetes or obesity. The study was published in JAMA Network Open.
“In patients with obesity who were prescribed semaglutide or liraglutide, we found that long-term weight reduction varied significantly based on the medication’s active agent, treatment indication, dosage and persistence with the medication,” said Hamlet Gasoyan, Ph.D., lead author of the study and a researcher with Cleveland Clinic’s Center for Value-Based Care Research.
This retrospective cohort study included 3,389 adult patients with obesity who initiated treatment with injectable semaglutide or liraglutide between July 1, 2015, and June 30, 2022. Follow-up ended in July 2023.
At the start of the study, the median baseline body mass index among study participants was 38.5; 82.2% had type 2 diabetes as treatment indication. Among the patients, 68.5% were white, 20.3% were Black, and 7.0% were Hispanic. More than half of the participants were female (54.7%). Most of the patients received treatment for type 2 diabetes. Overall, 39.6% were prescribed semaglutide for type 2 diabetes, 42.6% liraglutide for type 2 diabetes, 11.1% semaglutide for obesity, and 6.7% liraglutide for obesity.
Results show that one year after the initial prescription’s fill, weight change was associated with the following factors:
The medication’s active agent. On average, weight change was -5.1% with semaglutide versus -2.2% with liraglutide.
The dosage. Patients experienced -3.5% mean weight change with low maintenance dose versus -6.6% with high dose.
Treatment indication. Patients who received the medications for type 2 diabetes experienced -3.2% in mean weight change compared to -5.9% for obesity treatment.
Persistence with medication. On average, patients who were persistent with the medication at one year experienced -5.5% weight change versus -2.8% among patients who had 90-275 medication coverage days within the first year and -1.8% among those with less than 90 covered days.
Overall, 37.4% of patients receiving semaglutide for obesity achieved 10% or more body weight reduction compared to 16.6% of patients receiving semaglutide for type 2 diabetes. In comparison, 14.5% of those receiving liraglutide for obesity achieved 10% or more body weight reduction versus 9.3% of those receiving liraglutide for type 2 diabetes.
Among patients who persisted with their medication one year after their initial prescriptions, the proportion who achieved 10% or more weight reduction was 61% with semaglutide for obesity, 23.1% with semaglutide for type 2 diabetes, 28.6% with liraglutide for obesity, and 12.3% with liraglutide for type 2 diabetes.
Based on the study’s multivariable analysis that accounted for relevant socio-demographic and clinical variables, the following factors were associated with higher odds of achieving 10% or more weight reduction one year after the initial prescriptions:
Patients who received semaglutide versus liraglutide
A high maintenance dose of the medication versus low
Obesity as a treatment indication versus type 2 diabetes
Patients who persisted with the medication within the first year or had between 90-275 days of medication coverage versus less than 90 days of medication coverage
Patients who had higher initial BMI
Patients who were female versus male
“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,” said Dr. Gasoyan. “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.”
Reference: Gasoyan H, Pfoh ER, Schulte R, Le P, Butsch WS, Rothberg MB. One-Year Weight Reduction With Semaglutide or Liraglutide in Clinical Practice. JAMA Netw Open. 2024;7(9):e2433326. doi:10.1001/jamanetworkopen.2024.33326
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