Real-world data reveals factors associated with long-term weight loss in obesity

A Cleveland Clinic study identified key factors that may affect long-term weight loss in obese patients prescribed injectable semaglutide or liraglutide for the treatment of type 2 diabetes or obesity. The study JAMA Network Open.

“For obese patients prescribed semaglutide or liraglutide, we found that long-term weight loss varied widely depending on the active ingredient in the drug, therapeutic indication, dose and duration of treatment.”

Hamlet Gasoyan, PhD, lead author, Cleveland Clinic

Semaglutide (sold under the brand names Wegovy and Ozempic) and liraglutide (sold under the brand names Saxenda and Victoza) are glucagon-like peptide-1 receptor agonists, or GLP-1 RA drugs. These FDA-approved medications lower blood sugar levels and promote weight loss.

Obesity is a complex chronic disease that affects more than 41% of the adult population in the U.S. Although anti-obesity medications have been shown to be effective in clinical trials, there are limited data on factors associated with long-term weight change and clinically significant weight loss in the real-world setting.

In this study, researchers identified key factors associated with long-term weight loss in obese patients and also identified factors associated with the likelihood of achieving a weight loss of 10% or more.

This retrospective cohort study included 3,389 adult patients with obesity who initiated treatment with injectable semaglutide or liraglutide between July 1, 2015 and June 30, 2022. Follow-up ended in July 2023.

At the start of the study, study participants had a median baseline body mass index of 38.5, and 82.2% had type 2 diabetes as their treatment indication. Of the patients, 68.5% were white, 20.3% were black, and 7.0% were Hispanic. More than half of the participants (54.7%) were women. The majority of patients were being treated for type 2 diabetes. Overall, 39.6% were prescribed semaglutide for type 2 diabetes, 42.6% were prescribed liraglutide for type 2 diabetes, 11.1% were prescribed semaglutide for obesity, and 6.7% were prescribed liraglutide for obesity.

Results showed that one year after the first prescription was filled, weight change was associated with the following factors:

• Medication persistence. On average, patients who persisted on medication in the first year experienced a -5.5% weight change, compared with -2.8% for those on medication 90-275 days within the first year and -1.8% for those on medication <90 days.

The researchers found that four in 10 people (40.7%) were still taking their medication one year after their first prescription was filled: 45.8% of patients continued to take semaglutide and 35.6% of patients took liraglutide.

In patients who remained on medication at 12 months, semaglutide for obesity reduced weight by -12.9% compared to -5.9% for semaglutide for type 2 diabetes. Liraglutide for obesity reduced weight by -5.6% compared to -3.1% for liraglutide for type 2 diabetes.

Research has shown that achieving a sustained weight loss of 10% or more confers clinically significant health benefits. With this in mind, Dr. Ghasoyan and his colleagues looked at the percentage of patients who achieved a weight loss of 10% or more.

Overall, 37.4% of patients receiving semaglutide to treat obesity achieved at least 10% weight loss compared to 16.6% of patients receiving semaglutide to treat type 2 diabetes, while 14.5% of patients receiving liraglutide to treat obesity achieved at least 10% weight loss compared to 9.3% of patients receiving liraglutide to treat type 2 diabetes.

Among patients who continued taking the medication one year after their first prescription, the proportion of patients who achieved at least 10% weight loss was 61% for semaglutide for obesity, 23.1% for semaglutide for type 2 diabetes, 28.6% for liraglutide for obesity and 12.3% for liraglutide for type 2 diabetes.

Based on the multivariate analysis of the study, taking into account relevant sociodemographic and clinical variables, the following factors were associated with a high probability of achieving a weight loss of 10% or more one year after the first prescription:

“Our findings may help inform patients and healthcare providers about some important factors associated with the likelihood of achieving sustained weight loss that results in clinically significant health benefits,” said Dr. Gasoyan. “Having real-world data could help manage expectations regarding weight loss with GLP-1 RA medications and reaffirm the importance of persistence to achieve meaningful results.”

In a previous study, Dr. Ghasoyan and his colleagues investigated factors that influence long-term use of anti-obesity medications. Future studies will continue to examine continued use and health outcomes of patients on GLP-1 RA medications.

Dr. Gasoyan has received grant funding from the National Cancer Institute.