GLP-1 dispensing among adolescents, young adults rose from 2020 to 2023

Key takeaways:

• GLP-1 receptor agonist dispensing increased 659.4% among young women and 587.5% among adolescent girls.
• The findings highlight the need for education on sex-specific safety risks, researchers said.

Dispensing of GLP-1 receptor agonists increased nearly 600% among adolescents and young adults in the United States from 2020 to 2023 and was particularly significant among girls and young women, a new study showed.

According to Joyce M. Lee, MD, MPH, a professor of pediatrics and communicable diseases at the University of Michigan School of Public Health, and colleagues, interest in GLP-1 receptor agonists have soared in the past decade, especially after the 2021 approval of semaglutide (Wegovy, Novo Nordisk) for weight management in adults.

More recently, in December, the FDA approved semaglutide for weight loss in adolescents aged 12 to 17 years with an initial BMI in the 95th percentile for age and sex. However, “little is known about the use of these medications in younger patients,” Lee told Healio.

“We wanted to understand the extent to which these medications are being dispensed at a national level,” she said.

The researchers analyzed information from the IQVIA Longitudinal Prescription Database on GLP-1 receptor agonist dispensing from 2020 to 2023. The GLP-1 receptor agonists included dulaglutide (Trulicity, Eli Lilly), liraglutide (Saxenda, Novo Nordisk), exenatide (Bydureon, AstraZeneca), tirzepatide (Zepbound, Eli Lilly) and semaglutide.

Overall, the number of individuals aged 12 to 25 years with GLP-1 receptor agonist dispensing rose from 8,722 to 60,567 during the study period, for an increase of 594.4%.

In contrast, the number of those dispensed drugs other than GLP-1 receptor agonists fell from 12,683,040 to 12,282,525, for a decrease of 3.1%.

The number of girls and boys who were dispensed GLP-1 receptor agonists rose 503.8% and 587.5%, respectively.

Meanwhile, there was a 659.4% increase in young women, compared with a 481.1% increase in young men.

“This disproportionate dispensing may reflect a societal bias toward weight in females,” Lee told Healio.

Among adolescents, the researchers noted that the number who were dispensed exenatide, liraglutide or dulaglutide was greatest throughout the study period and increased steadily, whereas the number who were dispensed injectable semaglutide for weight management increased in 2023.

In young adults, the number of those dispensed liraglutide, dulaglutide or exenatide was greatest in 2020 and 2021, whereas the number dispensed injectable semaglutide for type 2 diabetes was greatest in 2022 and 2023.

Additionally, the number who were dispensed tirzepatide increased in 2022, whereas the number who were dispensed injectable semaglutide for weight management increased in 2023.

Most adolescents and young adults who were dispensed a GLP-1 receptor agonist in 2023 were female and from the South. In both age groups, the last dispensed prescription in 2023 was most often for injectable semaglutide for type 2 diabetes.

Adolescents were mostly prescribed GLP-1 receptor agonists by endocrinologists (32.7%), whereas young adults were mostly prescribed GLP-1s by nurse practitioners (33%).

“The rapid increase in dispensing suggests that there is significant demand for this medication in younger populations,” Lee said. “Primary care physicians will likely need education and training focused on this new class of medications, given a shortage of endocrinologists and obesity medicine specialists.”

Lee and colleagues noted there were study limitations, such as a lack of data on prescription indication, “including whether it was used off-label.”

“However, the increase in dispensing of injectable semaglutide for weight management suggests increasing use for this indication,” they wrote.

The finding that GLP-1 dispensing was highest in girls and women highlights “the importance of educating patients and prescribers on sex-specific safety risks,” the researchers noted.

“In females, the GLP-1 receptor agonists should not be taken during pregnancy or while breastfeeding,” Lee said. “In addition, female patients should be counseled that the medications may make birth control pills less effective.”

For more information:

Joyce M. Lee, MD, MPH can be reached at joyclee@med.umich.edu.