Tirzepatide and Semaglutide show superior one-year persistence and adherence over Liraglutide for weight management in military personnel.

Glucagon-like peptide-1 receptor agonists (GLP-1RAs) are increasingly vital for weight management and type 2 diabetes. While clinical trials establish their efficacy, real-world data on long-term treatment persistence and adherence are crucial for optimizing patient outcomes and informing formulary decisions. Understanding which GLP-1RA agents lead to better sustained use in diverse populations, such as active duty service members within the Military Health System (MHS), helps address gaps in current prescribing practices and resource allocation for chronic conditions.

This retrospective cohort study analyzed 10,649 active duty service members (ADSMs) who initiated therapy with liraglutide (Saxenda), semaglutide (Wegovy), or tirzepatide (Zepbound) between January 1, 2021, and December 31, 2025. Persistence was defined as the time to the first gap in therapy exceeding 90 days. Researchers used Kaplan-Meier survival analysis to estimate persistence rates and a multivariable Cox proportional hazards model to identify predictors of discontinuation, comparing outcomes across the different GLP-1RA agents.

Significant differences in treatment outcomes were observed across all agents. Patients initiating tirzepatide (Zepbound) demonstrated the highest mean yearly adherence (proportion of days covered [PDC]: 78.2%), followed by semaglutide (Wegovy) at 71.6%, and liraglutide (Saxenda) at 48.7%. One-year persistence was highest for Zepbound (81.9%) and Wegovy (70.7%), and significantly lower for Saxenda (34.2%) (log-rank P < .001).