A recent study has highlighted essential factors that can influence the long-term weight loss success of individuals with obesity who are undergoing treatment with injectable semaglutide or liraglutide for type 2 diabetes or obesity.
A study conducted by the Cleveland Clinic has pinpointed crucial elements that can affect the sustained weight loss of patients with obesity treated with injectable semaglutide or liraglutide for type 2 diabetes or obesity. The findings were published in JAMA Network Open.
According to Hamlet Gasoyan, Ph.D., the lead author of the study and a researcher at Cleveland Clinic’s Center for Value-Based Care Research, “We discovered that among patients with obesity treated with semaglutide or liraglutide, the long-term weight loss outcomes differed significantly depending on the active ingredient of the medication, the treatment rationale, the prescribed dosage, and the adherence to the medication.”
Semaglutide (marketed as Wegovy and Ozempic) and liraglutide (available under the names Saxenda and Victoza) are classified as glucagon-like peptide-1 receptor agonists, or GLP-1 RA medications. These FDA-approved drugs are effective in lowering blood sugar levels and promoting weight loss.
With obesity being a complex chronic condition affecting over 41% of adults in the U.S., clinical trials have shown the effectiveness of anti-obesity medications. However, there is a lack of comprehensive data from real-world scenarios on the factors influencing long-term weight management and clinically significant weight loss.
This retrospective cohort study analyzed 3,389 adult patients with obesity who began treatment with injectable semaglutide or liraglutide from July 1, 2015, to June 30, 2022, with follow-ups ending in July 2023.
At the study’s outset, the average baseline body mass index (BMI) of participants was 38.5, with 82.2% being treated for type 2 diabetes. The demographic breakdown included 68.5% white, 20.3% Black, and 7.0% Hispanic individuals, with more than half (54.7%) of the participants being female. A majority of patients were being treated for type 2 diabetes, with 39.6% receiving semaglutide, 42.6% getting liraglutide for diabetes, 11.1% using semaglutide for obesity treatment, and 6.7% using liraglutide for obesity.
The study’s findings demonstrated that after one year from the initial prescription, weight change correlated with several key factors:
- The active ingredient of the medication: Weight change was on average -5.1% with semaglutide compared to -2.2% with liraglutide.
- The dosage: Patients on a low maintenance dose saw a mean weight change of -3.5%, while those on a high dose experienced -6.6% weight change.
- The treatment reason: Patients receiving medications for type 2 diabetes had a mean weight change of -3.2%, whereas those treated for obesity had -5.9%.
- Adherence to the medication: Patients who remained consistent with the medication after one year noted an average weight change of -5.5%, in contrast to -2.8% for those with 90-275 medication coverage days, and -1.8% for those with less than 90 days.
The research indicated that 40.7% of patients were consistent with their medication one year after their initial prescription, with persistence rates of 45.8% for semaglutide patients and 35.6% for those on liraglutide.
Among the patients who adhered to their medication at the 12-month mark, the average weight reduction was -12.9% with semaglutide when used for obesity, compared to -5.9% for type 2 diabetes. For liraglutide, the average weight loss was -5.6% for obesity and -3.1% for type 2 diabetes.
Research indicates that achieving a sustained weight loss of 10% or more can yield significant health benefits. In this context, Dr. Gasoyan and his team evaluated the percentage of patients losing 10% or more of their body weight.
The results revealed that 37.4% of patients on semaglutide for obesity achieved a weight reduction of 10% or more, compared to 16.6% for those receiving semaglutide for type 2 diabetes. Among liraglutide users, 14.5% achieved over 10% weight loss for obesity, versus 9.3% for type 2 diabetes.
For those who adhered to their medication for a year, the percentage reaching 10% or greater weight loss was 61% for semaglutide (obesity), 23.1% (semaglutide for type 2 diabetes), 28.6% (liraglutide for obesity), and 12.3% (liraglutide for type 2 diabetes).
A multivariable analysis of the study, taking into account relevant socio-demographic and clinical factors, revealed the following elements associated with a higher likelihood of achieving a 10% or more weight reduction within a year after starting medication:
- Patients treated with semaglutide compared to those receiving liraglutide
- Those on a high maintenance dose versus a low one
- Patients treated for obesity versus those for type 2 diabetes
- Individuals who remained consistent with their medication during the first year or had 90-275 days of coverage, compared to those with less than 90 days
- Patients with a higher initial BMI
- Female patients versus male patients
Dr. Gasoyan commented, “Our study findings can guide patients and healthcare providers regarding important factors that can enhance the chances of achieving significant weight loss that is clinically beneficial.” He emphasized that real-world data can help set realistic expectations concerning weight loss with GLP-1 RA medications and highlight the importance of adherence to treatment.
In earlier research, Dr. Gasoyan and his team explored the factors affecting the long-term use of anti-obesity medications. Future studies will continue to investigate the persistence and health outcomes of patients using GLP-1 RA medications.
Dr. Gasoyan’s work is supported by a grant from the National Cancer Institute.
