Tracking GLP-1 Success: How Real-World Weight Loss Mirrors Clinical Trial Results—If Persistence Is Maintained

We are excited to invite you to watch a short, insightful conversation from our “Ask The Author” session featuring host Prof. Dufour and special guest, Dr. Jason Samuels, a surgeon and bariatric surgeon in Tennessee, USA.

Dr. Samuels recently published a significant paper in diabetes, metabolism and obesity, titled “Real World Titration Persistence and Weight Loss of Semaglutide and Tirzepatide in an Academic Obesity Clinic“. This conversation delves into the crucial real-world application of GLP-1 Receptor Agonists (GLP1RAs).

Why This Conversation Matters

Prof. Dufour, whose clinical practice involves seeing patients taking these drugs daily, highlights that the scheduled administration in clinical trials is often “not very flexible”. Dr. Samuels’ study offers essential real-world experience, showing how these treatments are administered and sustained outside of highly controlled trial settings.

The conversation centers on a single-center, retrospective observational study conducted at an academic obesity clinic. The study is unique due to its dataset, which is derived from the Vanderbilt Weight Loss Bundle, an add-on to a private insurance policy that covers GLP-1s for up to 18 months at no cost to the patient, thereby ensuring patient access to the medication, at least concerning cost. Furthermore, the study uniquely combines EHR data with claims data related to prescription fills, allowing researchers to be “quite confident” regarding when patients received their medication.

Key Real-World Challenges and Successes

The primary aim of the research was to determine the real-world titration, persistence, and effectiveness of GLP1RAs. Dr. Samuels shares several critical findings:

  • Persistence is a Challenge: Despite having no cost to the patient and access to dedicated obesity treatment providers, patients still struggle with persistence and adherence to recommended titration. Specifically, persistence with GLP1RA therapy, defined as continuous prescription fills without a gap of 84 days, was found to be moderate. Only about 50% of patients were still on the medication at 12 months after initiating therapy. The median persistence found in the study was 10.7 months.
  • Titration Adherence: Titration adherence was also moderate. For semaglutide users, 81% escalated to 1 mg, and 23% reached 2.4 mg; for tirzepatide users, 75% reached 10 mg, and 28% reached 15 mg. Patients struggle with following the recommended titration.
  • Effectiveness: Importantly, for those patients who do remain on the medication in a real-world setting, weight loss closely tracks the results described in clinical trials. For patients persistent for 12 months, the median weight loss was 14.4% (IQR 9.5%-20.5%), aligning with trial results such as around 15% to 18%.

Addressing the Knowledge Gap

The conversation also touches upon the “biggest gap” in current knowledge: the reasons why patients discontinue treatment. Dr. Samuels notes that frequently, patients stop individually without necessarily communicating this to their physicians. This gap is critical, especially since trials like STEP-4 and SURMOUNT-4 show that discontinuing the medication puts patients at a significantly high risk of weight regain.

Finally, Dr. Samuels discusses how these findings translate into clinical practice, emphasizing the need for education so patients understand the importance of remaining on these medications, potentially lifelong. If a patient elects to stop, communication with the care team is critical so that an deescalation plan can be developed to help maintain the weight loss.

Don’t miss this crucial “Ask The Author” discussion on the clinical application and real-world outcomes of these transformative anti-obesity drugs!

Watch the full short video of the conversation between Prof. Dufour and Dr. Samuels now.

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