6762 Real-World Analysis of Medication Access and Clinical Outcomes for Obesity Treatment with GLP-1s
Authors: Medeiros K L , Boyd K , Kenyon I , Ryan D 
Published: October 2024

Disclosure: K.L. Medeiros: None. K. Boyd: None. I. Kenyon: None. D. Ryan: Advisory Board Member; Self; Amgen Inc, Eli Lilly & Company, Novo Nordisk.

Glucagon-like peptide receptor agonist (GLP-1) medications have been utilized for diabetes treatment for nearly 20 years. Following the approval of semaglutide 2.4mg for a weight loss indication in 2021, the prescription of GLP-1s for obesity treatment skyrocketed. Pharmaceutical manufacturers have experienced numerous supply shortages, and insurance coverage has been challenging to navigate, leaving many patients untreated or with interruptions to medication access. In evaluating real-world patient cohorts for an entirely digital obesity and metabolic health program, we gleaned valuable information about GLP-1 access and the efficacy of a comprehensive program despite GLP-1 treatment disruptions. Patients were treated with GLP-1s and potential adjunct metformin in combination with a proprietary intensive lifestyle intervention. Medication selection was determined by physicians based on clinical appropriateness as well as insurance coverage and medication inventory. Patients were treated with semaglutide (as Ozempic®, Wegovy®, or Rybelsus®), liraglutide (as Saxenda® or Victoza®), tirzepatide (as Mounjaro®), or dulaglutide (as Trulicity®). Patients with at least one GLP-1 fill were eligible for evaluation. In addition to weight, metabolic markers, patient-reported outcomes, and medication safety, we assessed medication access and disruptions. For the n=12,821 cohort who completed at least 12 months (mo), patients had 7.74±5.79 (mean±SD) GLP-1 fills and accessed 1.62±0.81 distinct GLP-1 medications. 54.4% of the cohort accessed only 1 type of GLP-1 medication, while 32.58% accessed 2 distinct medications, and 13.01% accessed 3+ distinct medications. We evaluated medication disruptions for patients who filled through a partner mail-order pharmacy (n=9,111). A disruption was defined by the last script not being sent to a local pharmacy and at least 13 weeks without a fill. For these patients, 53% (n = 4,794) had at least 1 medication disruption, and 8.5% (n = 774) experienced multiple disruptions. We observed 16.2% average weight loss at 12 mo (n=11,429) and 17.2% at 24 mo (n = 650). In the n = 9,080 assessed for medication disruptions, we saw average weight loss of 17% at 12 mo (n = 4,002) and 18.6% at 24 mo (n=155) in those without a disruption, and for those with a disruption, average weight loss was 15.7% at 12 mo (n = 4,305) and 15.5% at 24 mo (n = 191). Despite a challenging landscape of insurance coverage limitations and supply shortages, patients who met criteria for obesity and metabolic health treatment were able to access GLP-1 treatment in this real-world evaluation. Even with significant gaps in medication access as well as other disruptions to medication continuity, patients enrolled in a commercially available medically-supervised obesity treatment program combining GLP-1s and a comprehensive ILI achieved clinically significant weight loss outcomes.

Presentation: 6/2/2024