Real-world semaglutide use achieves 13.8% weight loss in persistent patients; female sex linked to lower adherence

While novel antiobesity medications, particularly incretin mimetics like semaglutide, have shown significant efficacy in controlled clinical trials, there remains a critical gap in understanding their real-world effectiveness. Data on patient persistence and adherence to these costly therapies outside of trial settings are essential. Such real-world evidence is vital for informing health benefit design, managing healthcare costs, and setting realistic patient expectations for obesity treatment outcomes, especially given the chronic nature of the disease and the need for long-term medication use.

This retrospective, cohort, observational study analyzed prescription and clinical data from 393 patients within a single health system between 2021 and 2024. The index date was defined as the first semaglutide claim filled for weight loss, with refill data collected for up to 12 months. Electronic medical record data were gathered at 6 and 12 months. Persistence was defined as no therapy gap exceeding 60 days within 12 months. Adherence was measured as proportion of days covered (PDC) greater than or equal to 80%. Weight loss was calculated as percent change from baseline. Multivariable logistic regression identified factors associated with persistence and adherence at 12 months.

Out of 393 patients, 44% (172) remained persistent with semaglutide therapy throughout the 12-month follow-up period. These persistent patients achieved a mean weight loss of 13.8% from their baseline weight. In contrast, non-persistent patients experienced a mean weight loss of 6.4%. At the 12-month mark, 44% (175) of patients were found to be adherent to their semaglutide regimen, and this group experienced a 13% reduction in body weight. In multivariable logistic regression analyses, female sex was associated with significantly lower odds of persistence (odds ratio = 0.32; 95% CI = 0.14-0.75) and adherence (odds ratio = 0.33; 95% CI = 0.14-0.77) compared to male sex. Race, ethnicity, and comorbidities did not show statistically significant associations with either persistence or adherence.