Real-world Impact of Semaglutide, Liraglutide, and Tirzepatide on Weight Loss and Cardiometabolic Lab Measures: A Look into Drug Persistence and Reasons for Discontinuation (r/dc)
Author(s)
Katherine Cappell, PhD, Robert Sedgley, MS, Iris Chin, PhD, Richie Siburian, MA, Maryam Ajose, MPH, Mac Bonafede, MPH, PhD, Raunaq Malhotra, PhD, Janna Manjelievskaia, MPH, PhD;
Veradigm, Chicago, IL, USA
Veradigm, Chicago, IL, USA
Presentation Documents
OBJECTIVES: To assess the impact of three GLP-1 RAs on changes in weight (including BMI) and cardiometabolic measures (total cholesterol, LDL-C, HDL-C, triglycerides, apoB, lp(a), A1c) by persistence and uncover r/dc using a large language model (LLM).
METHODS: We identified adults newly initiating semaglutide, liraglutide, or tirzepatide between 06/04/2021-09/30/2023 (earliest event=index) using the Veradigm Network EHR linked to MarketScan claims. Patients had EHR/claims activity ≥12 months pre- and ≥24 months post-index, no pregnancy/delivery or bariatric surgery evidence, and no non-index GLP-1 RA use in follow-up. BMI and lab measures were captured at baseline and monthly in follow-up (clinical outcomes reported by persistence at patient-month level). R/dc were extracted from unstructured clinical notes using an LLM and evaluated by human review among a patient subset.
RESULTS: Of the 13,330 patients included, most were 55-64 years of age (40%), female (59%), and White (43%). 33% persisted on their index GLP-1 RA over follow-up; of those non-persistent, 27% discontinued use without restarting. Overall median baseline BMI and A1c were 35 kg/m2 and 7 mg/dL, respectively; total cholesterol was 162 mg/dL, LDL-C was 86 mg/dL, HDL-C was 45 mg/dL, triglycerides was 137 mg/dL, apoB was 90 mg/dL, and lp(a) was 24.3 mg/dL. Through follow-up, persistent users (vs discontinuers) showed greatest improvements in BMI, A1c, and lipids. Overall, most common r/dc were unknown (33%) and side effects (19%). By medication, this was also seen for semaglutide (30% and 21%, respectively) and liraglutide (42% and 14%); for tirzepatide, availability (39%) and financial issues (22%).
CONCLUSIONS: Persistent patients initiating GLP-1 RAs showed sustained improvements in weight loss and cardiometabolic lab levels. Reasons unknown and side effects were most common r/dc overall and among semaglutide or liraglutide; drug availability and financial issues were prevalent in tirzepatide users. LLMs can enhance structured data fields to gain deeper understanding of the patient clinical experience.
METHODS: We identified adults newly initiating semaglutide, liraglutide, or tirzepatide between 06/04/2021-09/30/2023 (earliest event=index) using the Veradigm Network EHR linked to MarketScan claims. Patients had EHR/claims activity ≥12 months pre- and ≥24 months post-index, no pregnancy/delivery or bariatric surgery evidence, and no non-index GLP-1 RA use in follow-up. BMI and lab measures were captured at baseline and monthly in follow-up (clinical outcomes reported by persistence at patient-month level). R/dc were extracted from unstructured clinical notes using an LLM and evaluated by human review among a patient subset.
RESULTS: Of the 13,330 patients included, most were 55-64 years of age (40%), female (59%), and White (43%). 33% persisted on their index GLP-1 RA over follow-up; of those non-persistent, 27% discontinued use without restarting. Overall median baseline BMI and A1c were 35 kg/m2 and 7 mg/dL, respectively; total cholesterol was 162 mg/dL, LDL-C was 86 mg/dL, HDL-C was 45 mg/dL, triglycerides was 137 mg/dL, apoB was 90 mg/dL, and lp(a) was 24.3 mg/dL. Through follow-up, persistent users (vs discontinuers) showed greatest improvements in BMI, A1c, and lipids. Overall, most common r/dc were unknown (33%) and side effects (19%). By medication, this was also seen for semaglutide (30% and 21%, respectively) and liraglutide (42% and 14%); for tirzepatide, availability (39%) and financial issues (22%).
CONCLUSIONS: Persistent patients initiating GLP-1 RAs showed sustained improvements in weight loss and cardiometabolic lab levels. Reasons unknown and side effects were most common r/dc overall and among semaglutide or liraglutide; drug availability and financial issues were prevalent in tirzepatide users. LLMs can enhance structured data fields to gain deeper understanding of the patient clinical experience.
Conference/Value in Health Info
2025-05, ISPOR 2025, Montréal, Quebec, CA
Value in Health, Volume 28, Issue S1
Code
CO65
Topic
Clinical Outcomes
Topic Subcategory
Clinical Outcomes Assessment
Disease
SDC: Diabetes/Endocrine/Metabolic Disorders (including obesity)