Presentation (CTI)

OBJECTIVES: The increasing use of glucagon-like peptide-1 receptor agonists (GLP-1 RAs) for both type 2 diabetes mellitus (T2DM) and weight management highlights the need to better understand prescribing patterns, adherence to approved indications, and equitable access to treatment. This pilot study aimed to characterize the population receiving treatment with GLP-1 RAs in Portuguese community pharmacies and to explore therapeutic indications, potential off-label use, reimbursement status, and treatment access.
METHODS: An observational, cross-sectional, exploratory pilot study was conducted using a digital questionnaire administered to adults (≥18 years) who had been dispensed semaglutide, liraglutide, or tirzepatide in Portuguese community pharmacies. The study was approved by the Ethics Committee of the University of Coimbra (CEIUC_R-26-02/2026). Sociodemographic, anthropometric, clinical, therapeutic, off-label use, treatment access, and persistence variables were collected. Data were analysed using descriptive statistics.
RESULTS: Fifty-three participants (mean age 57 years; similar distribution between sexes) were recruited from eight community pharmacies. Baseline body mass index (BMI) was calculable for 47 participants; 41 had obesity (87.2%). Reported indications included T2DM (50.9%, n=27) and weight management/obesity (47.2%, n=25). Ozempic® was the most frequently used medicine (58.5%, n=31), followed by Mounjaro® (34.0%, n=18). Overall, 62.3% (n=33) reported NHS reimbursement, including all participants treated for T2DM (100.0%, n=27/27) and 28.0% treated for weight management/obesity (n=7/25). Treatment continuity was affected by cost (39.6%, n=21) and medicine shortages (43.4%, n=23). Potential off-label use was identified in 7.5% (n=4) of participants (lipedema, n=2; weight management outside SmPC criteria, n=2).
CONCLUSIONS: GLP-1 RAs are widely used in Portuguese community pharmacies for both T2DM and weight management. Differences in reimbursement, treatment costs, stock shortages, and potential off-label use highlight challenges to equitable access and appropriate prescribing. Larger studies are needed to confirm and better characterize off-label use and support clinical, regulatory, and reimbursement decision-making.