A comprehensive three-year analysis of real-world GLP-1 obesity medication use reveals a stark persistence challenge, with only 8.1% of patients without diabetes continuing treatment for the full study period, according to new research from Prime Therapeutics LLC.
The study, which analyzed pharmacy and medical claims data from 16.5 million commercially insured members, focused on 5,780 adults with obesity but no diabetes who initiated GLP-1 therapy between January 2021 and March 2022. All participants remained continuously enrolled for three years, providing a robust dataset for long-term adherence analysis.
Significant Variations in Drug-Specific Persistence
The research revealed notable differences in persistence rates across GLP-1 products. Weekly semaglutide products, including Wegovy, demonstrated the highest three-year persistence at 14.3%, while daily liraglutide (Victoza) showed the lowest persistence at just 2.5%. The average proportion of days covered (PDC) across all participants was 37.5%, with only 12.5% of users classified as adherent over the three-year period.
"As we thoroughly collate and evaluate three years of studying GLP-1 obesity drug trends among real-world populations, new patterns are emerging that help us understand how these drugs are being used and how external factors may be impacting persistence and health outcomes," said Pat Gleason, PharmD, assistant vice president of health outcomes at Prime.
Dramatic Improvement in Short-Term Persistence
Despite poor long-term outcomes, the study identified encouraging trends in one-year persistence rates. Among patients initiating GLP-1 therapy in 2021, 33.2% remained persistent at one year. This figure nearly doubled to 62.7% for new initiators in the first quarter of 2024.
"During this time, there was a lot going on in the marketplace, with challenges to obtaining products and shortages," Gleason explained. "Doctors were still learning how to prescribe these products and manage patients. Care management and behavior management programs were not really adopted."
The improvement is largely attributed to the resolution of GLP-1 drug shortages in 2024 and enhanced clinical management practices. Physicians have become more adept at managing side effects associated with these medications, though the study did not quantify specific interventions such as anti-emetic prescribing rates.
Patient Demographics and Treatment Patterns
The study cohort had a mean age of 47 years, with nearly 80% identifying as female. More than one-third of users switched GLP-1 products during the three-year period, indicating ongoing challenges with treatment optimization and tolerability.
These findings align with broader literature confirming declining GLP-1 use over time. Earlier Prime research demonstrated similar patterns, with just 32% of members remaining on therapy at one year and only 15% persisting for two years.
Clinical Implications and Care Management
The research underscores the evolving understanding of obesity treatment as a long-term medical intervention requiring comprehensive support systems. "It's becoming clear that people need to be in therapy for more than just a few months," Gleason noted. "This is a chronic disease... If you want to get these benefits of cardiovascular debt reduction, you need to be on therapy for years, not months."
Dr. Marci Chodroff, vice president and medical director at Prime, emphasized the critical role of comprehensive care management: "Care management is essential for those taking GLP-1 drugs, and when providers and prescribers have access to real-world data, they're better informed to manage drug dosages, monitor for potential adverse effects and help with other areas, such as diet and exercise coaching."
Economic Considerations
The persistence challenges have significant cost implications for healthcare systems. Prime's previous research found no medical cost offsets for patients taking GLP-1 drugs to treat obesity, with medical costs actually increasing by an average of $1,338 per member compared to matched controls.
Prime plans to release additional findings on cost-of-care implications for three-year GLP-1 obesity therapy later in 2025, providing further insights into the economic impact of these treatments.
The research contributes to Prime's holistic GLP-1 management approach, which includes the KeepWell portfolio designed to support cardiometabolic health through app-based, provider-led interventions tailored to individual medication needs and lifestyle modifications.
