Factors affecting efficacy (in terms of weight loss) of GLP-1 agonists
A recent study from the USA identified key factors that can impact the long-term weight loss of patients with obesity who were prescribed injectable semaglutide or liraglutide for the treatment of type 2 diabetes or obesity (Gasoyan, 2024).
Key points
In the study, the following 6 factors were associated with greater weight loss:
- Semaglutide – versus liraglutide
- High maintenance dose – of the medication versus low
- Obesity – as a treatment indication versus type 2 diabetes – and higher initial BMI
- Persistence with the medication – within the first year or had between 90-275 days of medication coverage versus less than 90 days of medication coverage
- Female patients.
Semaglutide (sold under the brand names Wegovy and Ozempic) and liraglutide (sold under the brand names Saxenda and Victoza) are glucagon-like peptide-1 receptor agonists; also called GLP-1 agonists, or GLP-1 RA medications. These medications help lower blood sugar levels and promote weight loss.
Why is this study important?
Obesity is a complex chronic disease that affects a significant proportion of the UK adult population. In fact 26% of adults in England are obese and a further 38% are overweight (House of Commons library, 2023).
Clinical trials have shown that anti-obesity medications are effective; however, there is limited data in real-world settings regarding the factors associated with long-term weight change and clinically significant weight loss.
Obesity is a key factor in CKD (and ESRF) as it causes Type 2 diabetes, which is the cause of ESRF in 20% of patients on dialysis or with a transplant.
What did the study show?
This retrospective cohort study included 3,389 adult patients with obesity who initiated treatment with injectable semaglutide or liraglutide.
At the start of the study, the median baseline body mass index among study participants was 38.5; 82.2% had type 2 diabetes as treatment indication. 68.5% were white, 20.3% were Black, and 7.0% were Hispanic.
More than half of the participants were female (54.7%). Most of the patients received treatment for type 2 diabetes. Overall, 39.6% were prescribed semaglutide for type 2 diabetes, 42.6% liraglutide for type 2 diabetes, 11.1% semaglutide for obesity, and 6.7% liraglutide for obesity.
Results showed that after one year, weight change was associated with the following factors:
- The medication’s active agent. On average, weight change was -5.1% with semaglutide versus -2.2% with liraglutide
- The dosage. Patients experienced -3.5% mean weight change with low maintenance dose versus -6.6% with high dose
- Treatment indication. Patients who received the medications for type 2 diabetes experienced -3.2% in mean weight change compared to -5.9% for obesity treatment
- Persistence with medication. On average, patients who were persistent with the medication at one year experienced -5.5% weight change versus -2.8% among patients who had 90-275 medication coverage days within the first year and -1.8% among those with less than 90 covered days.
Amongst patients who persisted with their medication one year after their initial prescriptions, the proportion who achieved 10% or more weight reduction was 61% with semaglutide for obesity, 23.1% with semaglutide for type 2 diabetes, 28.6% with liraglutide for obesity, and 12.3% with liraglutide for type 2 diabetes.
How does this affect you?
If you are obese (with or without diabetes) and all previous attempts at weight loss (dieting, apps, exercise etc) have failed, you could consider asking for a GLP-1 agonist. The study shows there are particularly likely to be effective if you choose Semaglutide at higher dosage, are female, persistent with the drug, and are obese (without diabetes).
This is especially true for patients with milder stages of CKD (CKD1-3). In them, losing a significant amount of weight can be a very important way of preventing progression to CKD4 or CKD 5 (ESRF).
Last Reviewed on 16 September 2024
