OBJECTIVES: To evaluate the effect of persistence with and discontinuation of three GLP-1 RAs indicated for weight loss on changes in BMI, lipids, and A1c among adults over a 2-year follow-up.

METHODS: Using data from the Veradigm Network EHR linked to claims, we selected adult new users of semaglutide, liraglutide, or tirzepatide between 06/04/2021-09/30/2023. Earliest treatment was index. Patients had ≥12 months of enrollment before and ≥24 months following index, without evidence of pregnancy/delivery or bariatric surgery, and no other GLP-1 RAs during follow-up. Clinical characteristics (BMI and labs) were examined during baseline and monthly during follow-up. Adherence was examined during follow-up. Clinical outcomes were presented separately among patients who discontinued vs were persistent on GLP-1 RAs.

RESULTS: A total of 193,090 adults were included in the analysis; mean (SD) age was 55.5 (11.3) years; 59% were female; 65% had commercial insurance, 19% Medicare Advantage, 2% Medicare FFS, and 14% Medicaid. Nearly a third (28%) were persistent on GLP-1 RAs over a 24-month follow-up. Among the non-persistent cohort, 84% restarted a GLP-1 RA following discontinuation. Baseline median BMI and A1c were 34.6 and 7 overall. Baseline median lipid measures overall were 161 mg/dL for total cholesterol, 85 mg/dL LDL-C, 44 mg/dL HDL-C, 141 mmol/L triglycerides, 91 mg/dL apoB, and 34.5 mg/dL lp(a). During follow-up, median BMI and A1c were 34.2 and 7.1 among discontinuers compared to 33.6 and 6.9 among persistent patients. Follow-up total cholesterol was 155mg/dL among persistent patients compared to 165mg/dL among discontinuers, whose median value increased beyond their baseline measure following discontinuation. Similar trends were seen in other lipid measures.

CONCLUSIONS: Improvements in BMI, glucose control, and lipids are seen in patients persistent on GLP-1 RAs. Following discontinuation of GLP-1 RAs, patients’ clinical markers either return near baseline levels or worsen, suggesting patients need to remain on therapy to maintain benefits.