Adults receiving semaglutide as their first obesity medication lose more weight
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Key takeaways:
- Adults with obesity lost more weight with semaglutide if they did not use another obesity medication in the past.
- Medication-naive adults had similar weight loss as those who used to receive a non-GLP-1 drug.
Adults who previously used an obesity medication before receiving semaglutide lost less body weight at 12 months than those who did not use an obesity medication before semaglutide, according to study findings.
“To our knowledge, this is the first study assessing the association between previous use of anti-obesity medications and the weight loss outcomes of patients prescribed semaglutide for treatment of overweight or obesity,” Andres J. Acosta, MD, PhD, assistant professor of medicine at Mayo Clinic in Rochester, Minnesota, and colleagues wrote in a study published in Diabetes, Obesity and Metabolism. “In this cohort, in response to semaglutide, anti-obesity medication-naive patients had superior weight loss outcomes at 3, 6, 9 and 12 months when compared to patients who had previously received an anti-obesity medication other than semaglutide. However, it is noteworthy that a similar proportion of patients in both groups achieved a clinically significant total body weight loss of 5% or more and 10% or more at 12 months, which indicates the efficacy of this medication for both groups of patients.”
Researchers performed a retrospective cohort study with data from 305 adults with overweight or obesity who received once-weekly subcutaneous semaglutide (Wegovy, Novo Nordisk) at a Mayo Clinic center from 2021 to Jan. 15, 2023 (mean age, 49 years; 73% women). Body weight was obtained at baseline, 3, 6, 9 and 12 months after initiating semaglutide. Blood pressure and laboratory values were collected at baseline and 12 months. Researchers compared change in body weight and metabolic outcomes for adults who used an obesity medication before receiving semaglutide with adults who did not use another obesity medication in the past.
Of the study group, 76% had never used an obesity medication before semaglutide and 24% previously used another obesity medication. Of those who used a previous drug, 28% received the GLP-1 receptor agonist liraglutide (Saxenda, Novo Nordisk) and 72% used a non-GLP-1 medication.
Prior therapy and weight loss
Adults who used semaglutide as their first obesity medication lost more body weight at all timepoints than those who used a previous obesity medication. At 12 months, the obesity medication-naive group lost 14.3% of their body weight with semaglutide vs. a 10.6% weight reduction for those who used a previous medication (P = .01).
At 12 months, there were no differences in the proportion of adults who lost at least 5% and at least 10% of their body weight between the two groups. A greater percentage of participants in the obesity medication-naive group lost at least 15% of their body weight (48% vs. 21%; P = .02) and at least 20% of their body weight (27% vs. 4%; P < .01) compared with those who used an obesity drug before semaglutide.
At 3 and 6 months, adults who did not use a previous obesity medication had a greater weight loss than adults who previously used liraglutide and those who previously used a non-GLP-1 agent. At 9 and 12 months, previous liraglutide users continued to have a lesser weight loss than medication-naive adults; however, weight loss was similar between the obesity medication-naive group and adults who previously a non-GLP-1 obesity medication.
“Having been previously on liraglutide with a need to switch to another weight loss medication could be a potential risk factor for a suboptimal response with semaglutide,” the researchers wrote. “However, further prospective studies are still needed to fully address the difference in weight loss outcomes in patients switching their anti-obesity medication class.”
Differences in HbA1c change
Adults who did not use an obesity medication in the past had a greater reduction in HbA1c at 12 months than those who used a prior obesity medication (P < .001). No other differences in metabolic outcomes were observed.
The researchers said adults who used a prior obesity medication, especially liraglutide, may have characteristics that make them less responsive to subsequent pharmacotherapies. They said the findings support the use of precision medicine in obesity care.
“It is of utmost importance to tailor treatment based on a patient’s genes, environment and previous medication use, to improve overall outcomes, decrease patients’ exposure to a drug that might not be effective and be considerate of the financial burden that patients may endure,” the researchers wrote.
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