AddictionNews

Latest developments in causes and treatments

AddictionNews

AddictionNews

Understanding GLP-1 Discontinuation Rates

Photo of a man holding his hand in front of his face in a gesture of discontinuation.

GLP-1 receptor agonist drugs such as semaglutide and liraglutide are being hailed as new “miracle drugs” that help reduce overweight, restrain Type 2 diabetes (T2D), and have the potential to help with many other medical conditions. Sold under the brand names Ozempic, Wegovy, Mounjaro, and Zepbound, GLP-1 drugs have shown promise for treating alcohol use disorder, opioid use disorder, and even behavioral disorders such as gambling addiction, gaming addiction and shopping addiction.

Most of the promising results have come as a result of side effects from those using GLP-1 drugs for T2D, who report they also drink less, shop less and gamble less. Just as studies are rolling out testing GLP-1s for every condition under the sun, other studies are coming out about the long-term effects of using GLP-1 drugs.

Let’s begin by looking at studies on discontinuation rates for GLP-1 drugs. A study published in HCP Live on January 3 this year found a 49% discontinuation rate in the first year, averaged across 11 studies. Researchers say the discontinuation rates for people who do not have T2D are much higher than those who do:

Our findings indicate that nearly half of patients who begin a GLP-1 receptor agonist will discontinue within a year.

One large study found a discontinuation rate of 74% in the first year. Surprisingly, most of the studies did not specify the reasons for patient discontinuation of GLP-1 drugs. The authors of the research provide a list of reasons given, without any sense of which were cited most often: “adverse gastrointestinal (GI) events, high out-of-pocket costs, medication shortages, and a perceived lack of benefit.” 

It’s not clear how many of the 11 studies examined included patients who had to pay for the drug, which typically costs $800-$1,200 a month.

A 2020 study of GLP-1 discontinuation rates examined the insurance records of 4,791 patients with T2D who were prescribed GLP-1 drugs between January 2009 and December 2017. Among the findings:

  • The discontinuation rate was 47.7% at 12 months and 70.1% at 24 months
  • The median time to discontinuation was 13 months
  • The discontinuation rate is “significantly higher” for daily users vs. weekly users

In what might be the most understated conclusion I’ve seen, the authors say, “Reasons for non-adherence and discontinuation merit further research.” Exactly why are people discontinuing? This is all the researchers could come up with:

Finally, information that may explain the underlying reasons for these findings was unavailable. For example, it is possible that the gastro-intestinal side effects experienced when initiating therapy reported in clinical trials explains the low adherence and high discontinuation rates seen in this study, particularly in year 1. This is supported by the finding that, from the total cohort of 4709 patients in this study, 18.5% did not have a second prescription claim in their records. Generally, though, it is difficult to ascertain the reasons patients discontinue therapy in a claims database study as information on out of pocket expenses associated with these medications, side effects, or patient/provider preferences cannot be obtained.

A clinical review of GLP-1 drugs used to treat T2D explains how the drugs work: “Effects include increasing insulin secretion, decreasing glucagon release, increasing satiety, and slowing gastric emptying.” Nothing about the brain’s reward system in that description; it’s all about the gut. And so are the reasons cited for discontinuation: “The most common adverse effects seen with GLP-1 therapy include nausea, vomiting, and injection-site reactions.”

Half the people in these GLP-1 drug studies quit within a year, most of them presumably due to GI distress. Does that mean the other half are willing to put up with the discomfort for the weight loss? How many of the people who continue on GLP-1 drugs also report nausea, diarrhea, vomiting, and GI distress? Here are some of the granular details:

The majority of liraglutide-induced nausea patients were symptom free by week 6, while the same proportion of the exenatide-treated group was not symptom free until week 22. Interestingly, although treatment satisfaction was higher with liraglutide, there were more severe adverse effects associated with liraglutide therapy.

It sounds like regular users are able to get over the GI distress in time. However, many people stop taking the drugs before they reach that point. Further research on discontinuation rates for GLP-1 drugs might help us better understand how they work and how to moderate their side effects.

Written by Steve O’Keefe. First published January 30, 2025.

Sources:

“GLP-1 RA Discontinuations Frequent in People with Obesity Without Diabetes,” HCP Live, January 3, 2025.

“Real-World Adherence and Discontinuation of Glucagon-Like Peptide-1 Receptor Agonists Therapy in Type 2 Diabetes Mellitus Patients in the United States,” Patient Preference and Adherence, November 27, 2020.

“A clinical review of GLP-1 receptor agonists: efficacy and safety in diabetes and beyond,” Drugs in Context, July 9, 2015.

Image Copyright: olegtroino.

LEAVE A RESPONSE

Your email address will not be published. Required fields are marked *