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Truveta Research leads first study to explore GLP-1 reinitiation trends and factors

by | Jul 30, 2024 | Research

Truveta Research in collaboration with Ezekiel Emanuel, MD, PhD, explored trends and factors in the stopping and restarting of GLP-1 medications
  • This study characterized discontinuation and reinitiation of GLP-1 medications for a large population of patients with overweight or obesity who started a GLP-1 medication between 2018-2023. The study also identified factors associated with stopping and subsequently reinitiating – including weight change – the medications.
  • Of the 96,544 patients initiating a GLP-1 RA medication, 46% of patients with and 65% without type 2 diabetes (T2D) discontinued within 1 year. Weight loss, income, gastrointestinal adverse events, and comorbidities were significantly associated with discontinuation.
  • Following discontinuation, 51% of patients with and 35% without T2D reinitiated within a year. Weight re-gain since discontinuation was significantly associated with reinitiation.
Over 70% of US adults have obesity or overweight, resulting in estimated medical costs over $170 billion each year. While GLP-1 RA medications can successfully help treat type 2 diabetes and obesity, as well as improve cardiovascular health, evidence suggests they must be continued for sustained effects.

While some existing studies have explored discontinuation rates, they’ve identified widely varying rates of GLP-1 RA discontinuation at one year – and factors such as cost, insurance, comorbidities and absence of type 2 diabetes (T2D) have been associated with that discontinuation. The role of weight loss in discontinuation is not well understood. To our knowledge, no studies have characterized reinitiation of GLP-1 medications in the US.

In collaboration with Ezekiel Emanuel, MD, PhD — Vice Provost for Global Initiatives, the Co-Director of the Healthcare Transformation Institute, and the Diane v.S. Levy and Robert M. Levy University Professor at the University of Pennsylvania Perelman School of Medicine – Truveta Research shares a new study that is the first to explore GLP-1 reinitiation trends and factors among patients with overweight or obesity following discontinuation.

Key findings

Using Truveta Data, the study identified 96,544 patients who were new users of GLP-1 RAs (liraglutide, injectable semaglutide, or tirzepatide) with overweight or obesity (regardless of T2D) between 2018 and 2023.

Patients’ mean age at initiation was 55.1 (13.3) years, 65.2% were female, 73.7% were white, and 61.3% had T2D.  Among patients without T2D, 57.2% had Individual income over $50,000 a year, compared to 49.7% of patients with T2D.

Discontinuation trends and factors
Discontinuation was significantly higher for patients without T2D. Of the 96,544 patients initiating a GLP-1 RA medication, 46% of patients with and 65% without type 2 diabetes (T2D) discontinued within 1 year, accounting for censoring.

Weight loss, income, gastrointestinal adverse events, and comorbidities were significantly associated with discontinuation. Specifically, higher weight loss, absence of moderate or severe gastrointestinal adverse events, and higher income (only in the type 2 diabetes population) were significantly associated with lower discontinuation.

Truveta Research in collaboration with Ezekiel Emanuel, MD, PhD, explored trends and factors in the stopping and restarting of GLP-1 medications
Truveta Research in collaboration with Ezekiel Emanuel, MD, PhD, explored trends and factors in the stopping and restarting of GLP-1 medications
Reinitiation trends and factors
Reinitiation was significantly lower for patients without T2D. Of 28,142 who discontinued and had a discontinuation weight available, 51% of patients with and 35% without T2D reinitiated within a year.

Weight gain since stopping GLP-1 was significantly associated with higher reinitiation, while presence of any moderate or severe gastrointestinal adverse events during initial treatment was significantly associated with lower reinitiation.

Truveta Research in collaboration with Ezekiel Emanuel, MD, PhD, explored trends and factors in the stopping and restarting of GLP-1 medications

Perspective from authors

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. Significantly higher rates of discontinuation in patients without T2D – for whom insurance coverage may be limited – as well as higher incomes in this population at baseline suggest cost and access may play a role in uptake and sustained use.

The full study — including all findings, methodologies, limitations, and more — is available on MedRxiv.