If GLP1 is so great, why don't people stick with it?

Covering the benefits of GLP1s is great, covering new/novel negative side effects is even better, but finding out that one of the biggest problems with GLP1s is that people can't stick with them is quite the surprise.

Accessibility of GLP1s has reduced drastically this year with the phasing out of mass compounding, but prices have reduced from the $1000 MSRP that was quite common place in the past.

Recently some new research has shed light on yet another problem stopping GLP1s from revolutionizing weight management – they're hard to stick with over years.

Somewhat ironically, many people worry about not being able to get off GLP1s – i.e. whether weight rebounds when one stops taking the drugs (it doesn't, weight lost on GLP1s is sustainable), but it turns out one of the biggest issues is helping people stay on GLP1s long enough to improve health outcomes.

As reported by ManagedHealthcareExecutive.com, a longitudinal study done by Prime Therapeutics revealed that people have trouble staying on GLP1s for periods of 3 years:

Less than a third of people who took GLP1s were still taking them 1 year later, and less than 15% were taking them a year after that (i.e. after 2 years).

Primet Therapeutics performed and released information on an analysis they performed, which had surprising results.

Analysis: What did Prime Therapeutics find?

Here are the facts:

• 10,292 patients met study eligibility criteria:
  • Evidence of obesity in medical claims w/ no diabetes diagnosis
  • Drug therapy within 365 days from starting use of a GLP1 Receptor Agonist
• 5,780 (56.2%) continuously enrolled for 3 years after starting with a GLP1 drug
• The highest persistence measured was for Semaglutide (Wegovy) - 14.3%
• The lowest persistence measured was for Liraglutide (Victoza) - 2.5%

The numbers for the first year are quite surprising:

And the people sticking with it at year 3 are drastically lower:

It's not uncommon to switch GLP1s

One interesting notes from the data was the willingness of patients to switch GLP-1 drugs:

37.5% switched GLP-1 drugs at least once during the three

This is well-represented anecdotally, with many in online forums like Reddit asking about whether side effects were widely experienced – and many suggesting other GLP1s.

This is another aspect of GLP1s that is easy to take for granted – not every class of drugs (especially those that affect the brain) can be so easily substituted, with little to no additional side effects.

Why can't people stick with their GLP1 regimen?

Since this was simply an analysis of given data, it wasn't possible to simply ask all participants the reason for why they may have stopped treatment.

Researchers were also not quite so forthcoming on what could have caused this, leaving only the possibility of shortages and supply chain issues.

Along with those, there are at least a few reasons that spring to mind (many which come up anecdotally on online forums):

• Reaching weight loss goals/switching to "maintenance" (possibly with a cheaper drug)
• Lack of affordability/accessibility to the drugs
• Change in lifestyle/life circumstances

Unfortunately we can't do much other than speculate here.

Surprisingly, these results may not matter.

There's an important line towards the end of the paper that bears repeating:

The extremely low, three-year GLP-1 obesity treatment persistence seen among individuals initiating in 2021 and early 2022 may not be reflective of the current state as one-year persistence has nearly doubled between 2021 and the first quarter of 2024.

The data is old – while this analysis shows quite the trend, this was long before so many people understood and discussed the effects of GLP1s, their benefits and drawbacks.

If the meteoric increase in demand for GLP1s is any indicator, this study will be able to be repeated for years to come.