Cleveland Clinic Study Identifies Factors Associated With Long-Term Use of Popular Anti-Obesity Medications

Despite the publicity and promise of several new medications for chronic weight management, a recent study shows that only 19% of patients taking these drugs continue to take them one year after receiving their initial prescription. Determined to understand the factors associated with drug discontinuation – and conversely, persistence – a team of Cleveland Clinic researchers evaluated the use of several anti-obesity medications over a 12-month period.

Their findings were published in the Obesity Journal.

“Although patients now have access to effective FDA-approved anti-obesity medications, our research shows that in a real-world setting, most patients stop filling their prescription within the first year,” explains Hamlet Gasoyan, PhD, lead author of the study and a researcher with Cleveland Clinic’s Center for Value-Based Care Research. “To ensure the long-term success of our patients, we believe it’s important to better understand what factors lead them to abandon these treatments.”

The Center for Value-Based Care Research is part of the Department of Internal Medicine and Geriatrics within the Primary Care Institute at Cleveland Clinic in Cleveland, Ohio.

Obesity is a common, chronic disease attributed to several causes. According to the Centers for Disease Control and Prevention, obesity affects more than 41% of U.S. adults and increases the risk of major health complications, including cardiovascular disease and cancer.

A new generation of FDA-approved medications for chronic weight management, including glucagon-like peptide-1 (GLP-1) receptor agonists, appears to be effective for the treatment of obesity. However, only limited information is available about the long-term effects of these drugs, and discontinuing treatment has been linked to weight regain and reduced health benefits.

Study specifics

The aim of the Cleveland Clinic study was two-fold, explains Dr. Gasoyan. First, researchers wanted to evaluate the continued use of anti-obesity medications at several intervals (3, 6, and 12 months). Secondly, the investigators studied factors associated with continuous, long-term treatment (≥12 months).

“Ultimately, our goal was to gather information that could be used to help doctors, patients and policymakers navigate decisions regarding these newest weight-loss tools,” he says. "Real-world data is paramount in our ability to improve access to care."

The retrospective study showed that 44% of participants refilled their anti-obesity medication prescription at three months. At six months, 33% of the study participants were persistent with their treatment. At 12 months, only 19% of patients continued to refill their prescriptions.

The cohort included 1,911 adult participants with a body mass index (BMI) of 30 or greater who had an initial FDA-approved anti-obesity medication filled between 2015 and 2022. Dr. Gasoyan and his colleagues evaluated the percentage of participants who persisted with their treatment at three, six, and 12 months. Data, including sociodemographic variables, were obtained from electronic health records at Cleveland Clinic’s Ohio and Florida locations.

The prescriptions evaluated in the study included FDA-approved dosages for chronic weight management, including phentermine-topiramate, naltrexone-bupropion, orlistat, semaglutide injection 2.4 mg, and liraglutide injection 3 mg. Health insurance coverage was classified into private, Medicare, Medicaid, self-pay, and other categories.

Key takeaways

An estimated 40% of participants who received semaglutide continued to get their prescriptions filled at one year. In comparison, only 10% of participants who received an older-generation drug, such as naltrexone-bupropion, were still taking the medication one year later.

Importantly, investigators found that increased weight loss at six months increased the likelihood that a patient would continue the use of an anti-obesity drug for at least 12 months.

“Although the long-term use of anti-obesity medications remains low, our findings highlight factors that improve the odds of persistence,” says Dr. Gasoyan.

To further examine what considerations may contribute to the long-term use of anti-obesity medications, researchers also evaluated patients’ health insurance benefits. For participants with private insurance (84%), the coverage provided by their specific insurance carrier also appeared to influence the duration of treatment. Other determining factors included the medication type, percentage of weight loss at six months, and the year the first prescription was filled.

"We have more tools than ever before for the treatment of complex diseases like obesity; it's an exciting time," Dr. Gasoyan adds. "We hope future studies will improve our understanding of long-term weight trajectories and help clinicians and their patients make well-informed choices when choosing a treatment modality."