Most adults prescribed obesity drugs discontinue use at 3 months
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Key takeaways:
- Of adults who filled an obesity medication prescription, 33% continue use at 6 months and 19% at 1 year.
- Semaglutide had the highest persistence rate of all medications at 1 year.
More than 80% of adults who are prescribed an obesity medication discontinue taking them at 1 year, though persistence rates are higher for adults receiving semaglutide and liraglutide, according to study data.
“We are getting a better understanding of the persistence rates with anti-obesity medications in clinical practice as well as some of the key factors related to long-term receipt of medications for chronic weight management,” Hamlet Gasoyan, PhD, associate staff in the department of internal medicine and geriatrics, and investigator at the Center for Value-Based Care Research at Cleveland Clinic, and assistant professor of medicine at Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, told Healio. “Particularly, our findings indicate that while later-stage persistence with anti-obesity medications remains relatively low, patients receiving more effective anti-obesity medications and those experiencing greater medium-term weight loss have higher odds of persisting with anti-obesity medications at 1 year.”
Gasoyan and colleagues conducted a retrospective cohort study of adults with a BMI of 30 kg/m2 or higher who filled an initial prescription for an obesity medication from July 2015 to June 2022. Obesity medications included in the study were phentermine/topiramate, naltrexone/bupropion, orlistat (Xenical, Roche), subcutaneous semaglutide 2.4 mg (Wegovy, Novo Nordick) and subcutaneous liraglutide 3 mg (Saxenda, Novo Nordisk). Generic formulations of phentermine/topiramate and naltrexone/bupropion were included within those respective categories. Medication persistence at 3 months was defined as a cumulative gap of less than 15 days within 3 months of the initial prescription fill, 6-month persistence was defined as a cumulative gap of less than 45 days within 6 months of the first prescription fill, and 12-month persistence was defined as a cumulative gap of less than 90 days within the first year of the initial prescription fill. Total days of obesity medication coverage was collected for each participant. Percentage weight loss, BMI at baseline and sociodemographic variables were collected from electronic health records.
The findings were published in Obesity.
Persistence rates highest for semaglutide
There were 1,911 adults who filled an initial obesity medication prescription (mean age, 44 years; 75% women; 76% white). Participants were followed for a median of 2.4 years. Of the study group, 34% received naltrexone/bupropion, 26% received phentermine/topiramate, 25% received semaglutide, 14% received liraglutide and 0.9% received orlistat.
The percentage of adults continuing their obesity medication was 44% at 3 months, 33% at 6 months and 19% at 1 year. Persistence rates varied by medication. At 3 months, semaglutide had the highest persistence rate at 63%, followed by liraglutide at 52%, phentermine/topiramate at 36%, naltrexone/bupropion at 34% and orlistat at 11%. At 1 year, semaglutide had the highest persistence rate at 40%. Persistence rates were 17% for liraglutide, 13% for phentermine/topiramate, 10% for naltrexone/bupropion and 0% for orlistat at 1 year. Among adults who continued their medication at 1 year, the median number of days covered by an obesity medication was 504 days. For those who did not continue their medication, the median number of days covered was 120 days (P < .001).
In a multivariable-adjusted model, adults receiving semaglutide were more likely to continue their medication at 1 year than those receiving phentermine/topiramate (adjusted OR = 4.26; 95% CI, 3.04-6.05), whereas those receiving naltrexone/bupropion were less likely to continue their medication compared with phentermine/topiramate (aOR = 0.68; 95% CI, 0.46-1).
Among 524 adults who continued their obesity medication at 6 months, each 1% decrease in body weight was associated with a greater likelihood for continuing their medication at 1 year (aOR = 1.06; 95% CI, 1.03-1.09).
Studies on insurance design, interventions needed
“Our findings indicate that there is much work to be done to address the barriers to continued use of anti-obesity medications,” Gasoyan said. “At the same time, it was encouraging to see that patients receiving more effective anti-obesity medications and those experiencing greater medium-term weight loss have higher odds of later-stage persistence. These could be important findings for clinicians, policymakers, as well as researchers working in this field.”
Gasoyan said more research is needed to examine how certain insurance plans affect access to obesity medications and to develop interventions to increase medication persistence among adults with obesity.
“Our findings, along with future qualitative and population-based studies on determinants of non-persistence with obesity medications, could offer opportunities for more nuanced insurance-benefit design incorporating evidence-based usage management tools, rather than limiting or eliminating obesity medication coverage altogether,” Gasoyan said.
For more information:
Hamlet Gasoyan, PhD, can be reached at gasoyah@ccf.org.
Perspective
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At first glance, the percentage of patients that are actually taking their anti-obesity medication at 3, 6, and 12 months sounds dismal (44%, 33%, and 19% respectively). This is a major problem as it has been shown that the set point is permanently reset to the highest weight a patient has attained. Thus, it is particularly important for patients to stay on their medications if they wish to keep their weight down.
Of note is that the authors included patients that were taking semaglutide and liraglutide off label. It has been a common practice for some physicians to prescribe the diabetes form of semaglutide (Ozempic) and the diabetes form of liraglutide (Victoza) so that the medication would be covered even though the patient did not have diabetes. The insurance companies became wise to this and started to require proof of diabetes and if the patient did not have diabetes, coverage was stopped. Obviously, this would not explain all of the patients that stopped but there was a significant number who had to stop as they could not afford the medications.
The other reason that may explain why so many patients stop taking their anti-obesity medications is that they believe obesity is a temporary disease. “Once I get my weight down I don’t need anti-obesity medications.” There are some very good studies showing that when patients stop, they regain weight as fast as they lost it.
Last off, when they looked specifically at semaglutide, they saw that 40% of the patients were still on the medications at 1 year. This is a dramatic improvement. It is anticipated that patients will be better at long term compliance over time as the patients realize they are regaining weight when they stop. They will be coming back to their prescribing physician to get restarted.
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