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Patients taking glucagon-like peptide 1 (GLP-1) receptor agonists for obesity appear to be discontinuing the medications before they can have any meaningful impact on weight loss, according to two new studies.

In a large Blue Cross Blue Shield claims database, only about 42% of those prescribed the medications stayed on them beyond the 12 weeks required to achieve clinically meaningful weight loss, even as the number of prescriptions written to Blues enrollees soared from 20,000 in 2022 to 100,000 in 2023, reported Blue Health Intelligence, a unit of the Blue Cross Blue Shield Association and 17 of the nation's Blues plans.

But the group found that people prescribed GLP-1s by endocrinologists and obesity medicine specialists were 22% more likely to continue beyond 12 weeks than those prescribed the medications by primary care physicians. Half of those prescribed by endocrinologists and obesity medicine specialists — compared with 44% prescribed by primary care providers — continued beyond 12 weeks. But less than 10% of the prescriptions were written by endocrinologists or obesity specialists, Blue Health found.

Patients who saw physicians more often were more likely to continue beyond 12 weeks. Each additional visit increased that likelihood by about 60%, according to the report.

People between the ages of 18 and 34 years and those who face greater barriers to access to healthcare were the most likely to discontinue early.

Blue Health Intelligence analyzed 169,250 claims for GLP-1s (including liraglutide and semaglutide) prescribed for weight loss from July 2014 to December 2023. The dual glucose-dependent insulinotropic polypeptide/GLP-1 tirzepatide is not included as it wasn't approved for weight loss until November 2023.

The majority of those prescribed the medications were women, aged between 35 and 54 years, and had obtained a prescription from a primary care provider.

Lower co-pays increased the likelihood of continuation, especially when monthly costs were less than $60. Conversely, people paying at least $100 per month were slightly more likely to persist than those paying $60-$99. That "may be attributable to motivation related to substantial monetary investment in their treatment," according to the report.

People with comorbidities were less likely to continue beyond 12 weeks.

A similar report in JAMA Network Open found that patients with obesity were more likely to discontinue GLP-1s than those with diabetes. A total of 36% of those with obesity had stopped taking the medication by 3 months compared with 26% of those with diabetes, according to the report, which was published online on May 24.

Researchers from the Evernorth Research Institute (a wholly owned subsidiary of Cigna) and the Center for Value-Based Pharmacy Initiatives at the UPMC Center for High-Value Health Care studied prescription data for GLP-1s from January 2021 to January 2023, using a private database, the Komodo Healthcare Map.

They found that the odds of discontinuing the medications were highest for patients younger than 65 years and for those with only obesity. The authors found that the odds of discontinuation at 1 year were highest for men (odds ratio [OR], 1.02; 95% CI, 1-1.04) and for Black and Hispanic patients (OR, 1.08). Patients with greater social needs also were more likely to discontinue, along with those who had a new gastrointestinal diagnosis at the 12-month follow-up timepoint.

At 6 months, 45% of those with obesity stopped compared with 30% of those with diabetes. At 1 year, half of those with obesity had stopped compared with 36% of those with diabetes.

Although the authors did not look at out-of-pocket costs, it was cited as a potential reason for discontinuation.

The authors said they could not determine whether weight reduction or adverse effects could explain the higher prevalence of discontinuation among those with obesity.

"Discontinuation could have policy and medication coverage implications, especially if the weight reduction is not sustained after medications are discontinued," wrote the authors.

The JAMA Network Open study was supported by Evernorth and UPMC Health Plan's Center for Value-Based Pharmacy Initiatives.

Alicia Ault is a Saint Petersburg, Florida-based freelance journalist whose work has appeared in publications including JAMA and Smithsonian.com. You can find her on X: @aliciaault.