Obesity: Why do so many patients abandon GLP-1 agonists?

Scientific data is mounting to demonstrate the benefits of GLP-1 agonists in treating obesity and type 2 diabetes, as well as their comorbidities such as overall cancer risk and, in diabetes, peripheral artery disease.“This is a therapeutic field where, until recently, there were no truly effective treatments,” said Neda Nasseri, member of the Obesity Matters advisory committee, community pharmacist in Laval, Que. and product manager at Desjardins Insurance.Limited adherenceDespite all the benefits, data presented in the few studies on the subject reveal limited therapeutic adherence. In a retrospective study published in JAMA Network Open, conducted on more than 125,000 overweight or obese American adults, nearly 65% of non-diabetic participants and 46.5% of diabetic participants had discontinued their medication within the first year. Another study of more than 4,000 obese adults in the United States showed a persistence rate of only 32% after one year. This persistence varied greatly between molecules: 47.1% of respondents were still taking semaglutide (Ozempic), compared with 19.2% of patients taking liraglutide (Saxenda). Weekly treatments appeared to promote adherence more than daily injections.High costs and side-effectsA smaller Canadian study of 322 adults found that approximately 15% of patients stopped taking GLP-1 after one month due to adverse effects and high cost.Taking a drug like Wegovy can cost between $5,000 and $6,000 per year, Nasseri points out. However, the expected expiration of certain patents could facilitate access by paving the way for generics, as could the potential arrival on the market of tablets to replace injections.Adverse effects appear to be another common cause of discontinuation. Gastrointestinal symptoms, such as nausea, diarrhea, constipation or vomiting, are the most common and are usually temporary. More rarely, some patients experience symptoms such as fatigue, headaches, dizziness, or even more serious complications such as diabetic retinopathy or acute pancreatitis.“As with all medications, some patients respond very well and others respond less well,” observed Dr. Marie-Philippe Morin, a clinician-researcher at the Quebec Heart and Lung Institute at Laval University. “In our specialized clinic, adherence is fairly good, since we follow up with patients. We can adjust the doses, provide appropriate nutritional follow-up, or stop the medication completely when it's not working.”“If you stop taking your diabetes or high blood pressure pills, your blood pressure or blood sugar levels will rise. It’s the same with GLP-1s,” she added.Treating obesity as a chronic diseaseAccording to Nasseri, behind the issue of adherence to GLP-1 drugs lies a more structural challenge: recognizing obesity as a chronic disease requiring a multidimensional approach that includes psychological support, nutrition, exercise, pharmacology and, if necessary, bariatric surgery. “When you know you’re going to take a GLP-1, you have to be prepared to incorporate exercise and adequate protein intake with medications that curb your appetite,” explained Nasseri. “And I would say that people don’t usually do that.”“A conversation about obesity cannot be had by chatting for 10 minutes at the corner of a table,” said Nasseri. "A comprehensive analysis must be done on the patient and their health condition. Doctors are not paid to discuss obesity; there is no (billing) code for it. They may prioritize other issues, even though obesity is associated with many chronic diseases."Nasseri ultimately advocates for better financial coverage for obesity treatments, on par with other chronic diseases. “Obesity Matters supports expanded access to GLP-1 treatments and other obesity medications because they are very effective for weight loss,” she said. “Why are medications for migraines reimbursed, but not for obesity? This is definitely a societal issue that we need to address.”

Obesity: Why do so many patients abandon GLP-1 agonists?

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