Presentation (CTI)

OBJECTIVES: To characterize longitudinal GLP-1 receptor agonist treatment pathways, patient-centered outcomes, adherence, persistence, continuation, discontinuation, switching, re-initiation, and motivation to continue using sequential discussions from online patient community forums.
METHODS: A retrospective qualitative longitudinal study analyzed publicly available online community forum discussions from 2021 to 2026. De-identified patient identifiers linked posts and comments from the same individual chronologically, and timestamps were used to reconstruct treatment timelines. Inclusion required multiple patient-authored updates on distinct dates with sufficient temporal evidence to establish a journey. Large language model-assisted classification supported extraction of journey stages, patient-reported outcomes, barriers, facilitators, and pathway signals; researcher-reviewed coding determined final classifications. Two qualitative researchers independently reviewed outputs, resolving disagreements by consensus. Causal inference was not attempted.
RESULTS: Among 17,547 GLP-1-relevant patient-authored comments, 1,069 patients met longitudinal inclusion criteria. Median follow-up was 5.1 months. Treatment switching was observed in 372 journeys (34.8%; median follow-up, 6.2 months), access or reimbursement-related interruption in 244 (22.8%; 7.0 months), successful discontinuation in 241 (22.5%; 5.8 months), successful continuation in 228 (21.3%; 6.0 months), adverse-event discontinuation in 228 (21.3%; 5.6 months), and re-initiation after interruption in 133 (12.4%; 5.9 months). Journeys rarely followed a simple start, respond, and stay-on-treatment sequence. Instead, patients commonly started treatment, adjusted dose, experienced benefit or barriers, and then switched, interrupted, restarted, or continued. Motivation to continue was reinforced by perceived response, reduced food-related cognitive burden, improved mobility, daily functioning, emotional well-being, and fear of regain.
CONCLUSIONS: Community-derived longitudinal narratives identified distinct GLP-1 treatment journey patterns, including continuation, switching, interruption, discontinuation, and re-initiation, showing that persistence was adaptive rather than linear. These journey distinctions provide patient-centered context often missing from structured real-world data and may inform adherence research, journey mapping, patient support design, digital health methods, and hypothesis generation around treatment continuation, interruption, switching, and re-initiation.