New research published in JAMA Network Open led by Truveta Research and Ezekiel Emanuel, MD, PhD, Perelman School of Medicine at University of Pennsylvania
BELLEVUE, Wash. – January 31, 2025 – Truveta’s groundbreaking study analyzing real-world use of GLP-1 receptor agonist (GLP-1 RA) therapies in adults with overweight or obesity has published in JAMA Network Open, offering critical insights into GLP-1 discontinuation and reinitiation rates, and the roles income, adverse events, and weight changes may play.
Glucagon-like peptide 1 receptor agonist-based (GLP-1 RA) medications, including semaglutide and the dual GLP-1 RA/gastric inhibitory polypeptide (GIP) medication tirzepatide, have gained widespread popularity as treatments for type 2 diabetes and obesity. In collaboration with Ezekiel Emanuel, MD, PhD from the University of Pennsylvania Perelman School of Medicine, Truveta Research explored the factors associated with discontinuation and subsequent reinitiation of GLP-1 RAs among adults with overweight or obesity.
“Given the huge obesity and diabetes epidemics in the US, access to GLP-1 medications is a public health priority. Their potential is only realized if patients can afford and access them,” said Ezekiel Emanuel, MD, PhD, vice provost for Global Initiatives, co-director, Healthcare Transformation Institute, University of Pennsylvania and senior author on the paper. “This study sheds light on the challenges for real-world patients of staying on these medications and highlights the need to tackle barriers such as cost, insurance coverage, and equitable policies to ensure availability. Without these measures, we risk widening health disparities and denying countless individuals the chance to improve their health and quality of life.”
Key findings
Using Truveta Data, the study included 125,474 adults with a baseline body mass index (BMI) of 27 or higher who initiated treatment between January 1, 2018, and December 31, 2023. The study followed patients for up to two years to assess discontinuation (e.g., stopping their GLP-1 RA) and for an additional two years to monitor reinitiation (e.g., restarting a GLP-1 RA). Patients were grouped based on the presence of type 2 diabetes (T2D) at treatment initiation, with 76,524 (61%) individuals having T2D.
- Discontinuation within one year was significantly higher in patients without T2D (64.8%) compared to those with T2D (46.5%).
- The study found that when patients experienced greater weight loss, they were less likely to discontinue the GLP-1 RA medications. A 1% reduction in weight from baseline was associated with approximately 3% lower likelihood of stopping a GLP-1 RA. As an example, for a person weighing 200 pounds at initiation, losing 10 pounds (a 5% change in weight) was associated with a 15% lower likelihood of discontinuation, whereas losing 5 pounds (2.5% change in weight) was associated with an 8% lower likelihood of discontinuation.
- Among patients with T2D, higher income was associated with lower discontinuation. Those with incomes of $30,001-50,000, $50,001-80,000, and >$80,000 were 12%, 20%, and 28% less likely, respectively, to stop treatment, compared to those with incomes <$30,000.
- Moderate or severe gastrointestinal side effects were strongly associated with higher likelihood of discontinuation.
- Of 41,792 patients who discontinued and had post-discontinuation weight data, 1-year reinitiation was lower in patients without T2D (36.3% restarted within a year) compared to those with T2D (47.3% restarted within a year).
- Weight gain after stopping a GLP-1 RA was associated with a higher likelihood of restarting; a 1% weight gain after discontinuation was associated with approximately a 2.5% higher likelihood of restarting GLP-1 RA. As an example, for the person who initiated at 200 pounds, lost 10 pounds at the time of discontinuation (5% reduction in weight), a regain of 6 pounds since stopping (3% increase in weight) was associated with an 8% higher likelihood of restarting, compared to someone who did not regain any weight.
“Our findings highlight that, despite large increases in GLP-1 RA initiation, many patients stop these medications within a year, especially those without T2D, for whom insurance coverage may be limited,” said Tricia Rodriguez, PhD, MPH, principal applied research scientist, Truveta and lead author of the study. “Understanding how weight changes, side effects, and income relate to treatment discontinuation and reinitiation can inform clinical and policy strategies to ensure equitable access to GLP-1 RAs for patients who need them.”
“Improved understanding of the factors related to discontinuation and reinitiation of GLP-1RAs is essential for personalizing treatment to each patient’s unique health needs and circumstances,” said Ty J. Gluckman, MD, MHA, FACC, FAHA, FASPC, cardiologist, Providence Health, medical director at the Center for Cardiovascular Analytics, Research, and Data Science (CARDS), Providence Heart Institute, and an author on the paper. “These insights allow us to identify barriers and align treatment plans with patients’ goals and lifestyles. Equally important is fostering a strong partnership between patients and their clinical teams, ensuring open communication and shared decision-making. This collaborative approach empowers patients to achieve the best possible outcomes and receive the care they truly deserve.”
This research was conducted using Truveta, which offers the most complete, timely, and clean regulatory-grade electronic health record (EHR) data from more than 120 million patients. Truveta Data is representative of inpatient and outpatient care from over 800 hospitals and 20,000 clinics. Truveta Data is updated daily for the most current view of patient care. By providing a complete view of the patient journey, including clinical notes and medical images, Truveta enables researchers to accelerate therapy adoption, improve clinical trials, and enhance patient care. These data were then analyzed using Truveta Studio, which enables scientifically rigorous, fast, and compliant analytics.
To learn more about Truveta, visit Truveta.com.
About Truveta
Truveta is a collective of US health systems with a mission of Saving Lives with Data, delivering the most complete, timely, and clean regulatory-grade EHR data for scientifically rigorous research. Truveta and its health system members lead the Truveta Genome Project, creating the world’s largest and most diverse genomics database to discover the science of humanity. Truveta is trusted by leading public health, life science, healthcare, and academic organizations to accelerate discovery and adoption of new therapies, improve clinical trials, and enhance patient care.
Truveta membership includes Providence, Advocate Health, Trinity Health, Tenet Healthcare, Northwell Health, AdventHealth, Baptist Health of Northeast Florida, Baylor Scott & White Health, Bon Secours Mercy Health, CommonSpirit Health, Hawaii Pacific Health, HealthPartners, Henry Ford Health, HonorHealth, Inova, Lehigh Valley Health Network, MedStar Health, Memorial Hermann Health System, MetroHealth, Novant Health, Ochsner Health, Premier Health, Saint Luke’s Health System, Sanford Health, Sentara Healthcare, Texas Health Resources, TriHealth, UnityPoint Health, Virtua Health, and WellSpan Health.