Many people using GLP-1 for weight loss stop treatment too soon, research shows, and the results are not consistent.

CNN
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Demand for Wegovy and other GLP-1 drugs used to treat obesity and diabetes has soared, but a new report suggests many people may not stick with their weight loss treatment long enough.

An analysis of health insurance claims released Tuesday found that most people using GLP-1 drugs — about 58% — had been following their treatment plan for less than 12 weeks, which falls short of a key benchmark in the timing of weight loss treatment. Professional organizations have set this as a guideline for when to reevaluate whether a treatment results in clinically significant weight loss.

Users start with a low dose of these medications and gradually increase it over time. until they reach a targeted dose. But the analysis shows that almost a third of people – more than 30% – dropped out of treatment after the first four weeks of treatment, before reaching the targeted dose.

The findings are based on pharmaceutical and medical data on approximately 170,000 people with insurance coverage under Blue Cross Blue Shield plans who were prescribed GLP-1 medications approved to treat weight management between 2014 and 2023.

“These are long-term medications intended to treat chronic disease,” said Dr. Disha Narang, an endocrinologist and director of obesity medicine at Endeavor Health in Chicago, who was not involved in the new research. “It’s absolutely a marathon, not a sprint. And when we treat this as a sprint, I think patients are likely to stop their treatment much more quickly.

Experts say impatience with results is one of many reasons patients might stop treatment. According to a new KFF poll, only about two-thirds of adults who have used injectable medications for weight loss say they feel they have been effective. And people who stopped using these drugs were significantly less optimistic about their benefits: Only about half of those who had used injectable drugs for weight loss in the past said they were effective, compared with nearly half of those who had used injectable drugs for weight loss in the past. three-quarters of those actively using these treatments. .

Side effects – such as nausea, diarrhea, vomiting and constipation, common at first – can also scare people away. Data from the longest clinical trial on Wegovy showed that 17% of people using the drug decided to stop participating in the trial due to side effects.

But experts say many deterrents can be managed with proper guidance from a provider.

“If you don’t have frequent touchpoints, frequent interactions, then it’s really difficult to manage the side effects. It’s hard to manage expectations. It’s hard to see if there’s an improvement in some of these other metabolic comorbidities,” said Dr. Jody Dushay, an endocrinologist at Beth Israel Deaconess Medical Center and assistant professor of medicine at Harvard Medical School who was not involved in the new research.

Each person will respond differently to treatment and will assess the cost/benefit ratio for their health differently.

“There is no limit for each person. Doctors and patients simply need to look at all the data and make a decision about treatment together,” she said.

The findings from Blue Cross Blue Shield data highlight the important role providers can play in helping patients adhere to their GLP-1 treatment.

People who met with their providers less frequently — and those living in underserved areas with greater health inequities — were more likely to discontinue GLP-1 treatment sooner. Each additional follow-up visit increased a patient’s chance of remaining on treatment by 60%, said Dr. Razia Hashmi, vice president of clinical affairs for the Blue Cross Blue Shield Association.

And although most prescriptions came from primary care doctors, those who were prescribed GLP-1 by endocrinologists or others were more likely to reach at least 12 weeks of continuous treatment.

“Comprehensive support services really make a difference – whether a person has support with lifestyle management, nutrition, diet and side effect management,” Hashmi said, and “l “Health equity matters.” Social factors of health – transportation, access to food, socio-economic status – all make a difference too.

Cost can often be a prohibitive factor for these drugs – a monthly supply of GLP-1 drugs can often cost around $1,000 – but the analysis only included people with insurance plans that cover prescriptions for weight loss medications. Insurance plan co-pays may have influenced cost considerations, but people in this analysis were not paying out-of-pocket for their treatment.

But using GLP-1 treatments remains an investment in many ways.

“Whether it’s an employer trying to make a decision or an individual patient trying to make a decision, it’s really important to understand the factors for success,” Hashmi said. “We want the investment to bear fruit. »

Another new report supports the claim that the benefits of GLP-1 are prolonged by consistent long-term treatment.

One of the first reports offering real-world data on the effectiveness of GLP-1 found that people using the drugs lost an average of about 1.4% of their initial body weight after three months, with the figure increasing steadily until ‘at an average of about 3% weight loss. after a full year of treatment. The analysis from Dandelion Health, a healthcare analytics company, is based on electronic health records of nearly 17,000 people who were prescribed a GLP-1 between 2019 and 2023.

Compared to a group of people with a similar set of clinical characteristics – closely related to demographic factors such as age and ethnicity, treatment indicators such as average body mass index and prevalence of diabetes , history of treatments such as bariatric surgery and the prevalence of associated comorbidities – the analysis found that those who took GLP-1 lost about twice as much weight.

These injected medications, called GLP-1 agonists, are in high demand because they have been shown to be very effective for weight loss. In clinical trials, some of the most powerful medications, like Wegovy and Zepbound, have been shown to help people lose at least 10% of their initial weight. But the A new report suggests that actual effectiveness is not as promising as clinical trial data suggests.

And experts caution that the GLP-1 treatment process can be different for everyone.

“There are some people who don’t respond enough, others who respond too much, and still others who respond as expected to the medication,” Narang said. “Studies are still underway to understand why. »

Data from Dandelion Health showed that the 10% of people with the best response to GLP-1 had results that mirrored those found by clinical trials, but the 10% with the least success with the treatments did not. weight change, or even an increase in their weight. weight, over time.

Yet GLP-1 drugs may have benefits far beyond weight loss – for heart and liver health, for example – and may even extend to people who don’t lose as many pounds as they would have. could have hoped for, experts say.

“It’s really important not to use the scale as the sole criterion for whether you should continue taking this medication. People might make slow but steady progress, which might warrant continued treatment,” Dushay said. “The medication may have some direct benefits in the absence of significant weight loss, which is also why you should talk at length with your doctor about why you are using this medication.”