A retrospective study of 7,881 adults with obesity found that continued use of semaglutide or tirzepatide may result in greater weight loss and improved glycemic control compared with early discontinuation.

In the study, investigators analyzed electronic health records and pharmacy data from Cleveland Clinic locations in Ohio and Florida between January 2021 and December 2023. All of the patients had obesity or overweight with comorbidities and no type 2 diabetes at baseline.

The patients lost an average of 8.7% of body weight after 1 year. Those who continued treatment for the full year lost 11.9% on average. The patients who discontinued early, within 3 months of initiating treatment, lost 3.6%, whereas late discontinuers, who stopped between 3 and 12 months, lost 6.8% (P < .001).

Among the participants, 6,109 initiated semaglutide and 1,772 initiated tirzepatide. Tirzepatide users experienced greater weight loss compared with semaglutide users, with mean reductions of 12.4% and 7.7%, respectively. On high-dose maintenance regimens, tirzepatide users lost 18% on average compared with 13.7% with semaglutide users.

In multivariable analysis, the patients who remained on therapy had a higher likelihood of achieving at least 10% weight loss compared with early discontinuers. Late discontinuers also had a higher likelihood compared with early discontinuers. Tirzepatide use, higher doses, and female sex were associated with a greater likelihood of achieving at least 10% weight loss.

In a subgroup of 895 patients with prediabetes at baseline, the mean absolute reduction in glycated hemoglobin (HbA1c) was 0.3% at 1 year. The patients who continued therapy had a reduction of 0.4%, while early and late discontinuers saw reductions of 0.1% and 0.2%, respectively (P < .001).

At 1 year, 67.9% of the patients who continued therapy achieved normoglycemia compared with 41% of late discontinuers and 33.1% of early discontinuers. Overall, 3.4% progressed to type 2 diabetes, with the highest progression among early discontinuers.

Overall, 20.4% discontinued treatment early and 32% discontinued later. Discontinuation rates in the real-world study were higher compared with those reported in phase 3III trials of semaglutide and tirzepatide.

The findings may help guide clinical decision-making on medication continuation and dosing in obesity and prediabetes management.

Full disclosures can be found in the published study.

Source: Obesity