A stewardship framework for incretin-based therapies in weight management.

Abstract

Background: Use of incretin-based therapies, including GLP-1 and GIP receptor agonists, for weight management and related cardio-kidney-liver-metabolic comorbidities has expanded rapidly, yet real-world practice is challenged by inconsistent prescribing, access barriers, limited long-term safety data, low treatment persistence, and concerns regarding equity and financial sustainability. These gaps highlight the need for a structured, coordinated stewardship model to guide safe and evidence-based use of incretin-based therapies.

Objectives: To develop a scalable, multidisciplinary stewardship framework for incretin-based therapies that supports consistent and efficient prescribing practices, optimizes patient outcomes, strengthens medication access and safety monitoring, and defines the role of pharmacists in chronic weight management.

Methods: Two sequential expert workgroups were convened, composed of clinicians and pharmacy leaders from 21 health systems. Workgroup 1 identified foundational stewardship elements drawing from established antimicrobial and opioid stewardship models. Workgroup 2 applied these core principles to incretin-based therapies, informed by real-world challenges, emerging evidence, and clinical experience in weight and diabetes management. Consensus was established using a Delphi process, with ≥60% agreement required for inclusion.

Results: Workgroups reached consensus on a stewardship framework comprising multidisciplinary leadership, stakeholder engagement, pharmacy expertise, defined priorities, evidence-based interventions, education, data and reporting strategies, communication pathways, and mechanisms for feedback and continuous assessment. In addition, consensus-based pharmacist-led initiatives and metric categories were developed to support implementation and program evaluation across varied ambulatory environments, with pharmacists identified as central to therapy initiation and titration, adverse effect management, access navigation, patient education, and care coordination.

Conclusion: A structured stewardship model offers a feasible and scalable approach to optimize incretin-based therapies in weight management. By integrating multidisciplinary collaboration with pharmacy expertise and clinical and operational strategies, health systems can promote safe, equitable, and sustainable use of these therapies, improve population-level outcomes, and safeguard long-term value amid rapidly expanding utilization.