Real-world semaglutide use shows frequent discontinuation but substantial **-13.6%** weight loss in persistent users
Background
Obesity and overweight are chronic conditions associated with numerous health complications, yet effective long-term weight management remains a significant challenge. While clinical trials have demonstrated high efficacy for semaglutide in weight management when strict adherence and dose titration protocols are followed, real-world utilization often deviates from these controlled settings. Understanding how semaglutide performs in routine primary care, including actual dose titration patterns and discontinuation rates, is crucial for informing clinical practice and setting realistic patient expectations beyond trial conditions.
Study Design
This retrospective, observational study analyzed real-world use of semaglutide for weight management in 206 adults (76% women; mean age 48 years) prescribed the medication between December 2022 and May 2024 in one general practice in Denmark. The primary outcome was the relative mean change in body weight from baseline to 12-months follow-up in individuals who had not permanently discontinued treatment and had both baseline and follow-up weight measurements. Data on dose titration and discontinuation patterns were also collected.
Results
At 12 months after treatment initiation, 38% (n=78) of individuals had permanently discontinued semaglutide, while 15% (n=30) had temporarily paused treatment. Approximately 48% (n=98) remained on treatment. Among those still on treatment, dose distribution varied significantly from trial protocols: 40% were treated with ≤1.0 mg/week, 30% with 1.7 mg/week, and 30% with 2.4 mg/week.
Despite frequent discontinuation and slower, lower dose titration compared to approved labeling, the relative mean body weight change after 12 months for individuals who had not discontinued treatment was substantial at -13.6% (95% CI -15.0 to -12.2%). The mean baseline body weight for the cohort was 105 kg (SD 23.8).
Key Findings
- 38% of individuals permanently discontinued semaglutide for weight management within 12 months.
- 48% of patients remained on semaglutide treatment after 12 months.
- Among persistent users, 40% were on ≤1.0 mg/week, 30% on 1.7 mg/week, and 30% on 2.4 mg/week.
- Mean weight loss for individuals who did not discontinue treatment was -13.6% at 12 months.
- Real-world dose titration was slower and often to lower maintenance doses than recommended in trials.
Why It Matters
Real-world data confirms semaglutide's significant efficacy even with varied adherence and titration patterns, suggesting flexible dosing strategies may still yield substantial weight loss. This insight is critical for clinicians and individuals using peptides for weight management, as it indicates that achieving the maximum approved dose isn't always necessary for meaningful results. For those considering or currently using semaglutide, this study highlights that while discontinuation is common, persistence, even at lower doses, can lead to impressive outcomes. It underscores the importance of patient counseling on adherence and managing expectations regarding the titration schedule, acknowledging that real-world protocols often differ from strict trial designs.
semaglutide
weight-management
obesity
real-world-evidence
observational-study
dose-titration