Discontinuation and Reinitiation of GLP-1 Receptor Agonists Among US Adults with Overweight or Obesity

Abstract

Importance: Adherence to GLP-1 RA is important for efficacy. Discontinuation and reinitiation patterns for patients with and without type 2 diabetes (T2D) are not well-understood. Objective: To describe rates and factors associated with discontinuation and reinitiation of GLP-1 RA, for patients with and without T2D. Design: In this retrospective cohort study, adults with overweight or obesity initiated on GLP-1 RA between January 2018 and December 2023 were identified using electronic health record (EHR) data from a collective of 30 US healthcare systems. Patients were followed for up to 2 years to assess discontinuation and for 2 additional years to assess reinitiation. Setting: Clinical and prescribing data from EHRs linked to dispensing information Participants: Adults newly initiated on GLP-1 RA between 2018 and 2023, with a baseline BMI [≥]27 and an available weight measurement within 60 days before initiation, and regular care in the year before initiation. Exposure/Covariates: Patients were stratified by presence of T2D at baseline. Associations with socio-demographics, health factors, weight changes, and gastrointestinal (GI) adverse events (AE) were modeled. Main Outcomes and Measures: Proportion of patients discontinuing and reinitiating GLP-1 RA were estimated from Kaplan-Meier models. Associations between covariates and discontinuation and reinitiation outcomes were modeled using time-varying Cox proportional hazards models. All analyses were conducted for patients with and without T2D. Results: Among 96,544 adults initiating GLP-1 RA, the mean (SD) age was 55.1 (13.3) years, 65.2% were female, 73.7% were white, and 61.3% had T2D. Individual income exceeded $50,000 for 49.7% of patients with and 57.2% of patients without T2D. One-year discontinuation was significantly higher for patients without T2D (65.1%), compared to those with T2D (45.8%). Higher weight loss, absence of GI AE, and higher income (T2D only) were significantly associated with higher discontinuation. Of 28,142 (49.6%) who discontinued one-year reinitiation was lower for those without T2D (34.7%), compared to those with T2D (51.0%). Weight re-gain was significantly associated with increased reinitiation. Conclusions and Relevance: Most patients with overweight or obesity discontinue GLP-1 RA within 1 year, but those without T2D discontinue at higher rates and reinitiate at lower rates. Inequities in access and adherence to effective treatments have the potential exacerbate disparities in obesity.