Abstract Body: Background: Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) were originally approved for diabetes treatment (liraglutide in January 2010, semaglutide in December 2017, and tirzepatide in May 2022). Recently GLP-1 RAs have also been approved to manage obesity (liraglutide in December 2014, semaglutide in June 2021 and tirzepatide in September 2023). We seek to describe characteristics of recent GLP-1 RA users (2016-2023) and document temporal trends in GLP-1 RA prescription use, stratified by diabetes status.

Methods: We used MarketScan administrative claims databases (2016-2023) to construct a cohort of enrollees prescribed GLP-1 RAs via outpatient pharmaceutical claims. Diabetes and comorbid conditions included in the Charlson Comorbidity Index (CCI) were defined using inpatient and outpatient ICD-10-CM codes. Demographic information was measured from enrolment data at time of first GLP-1 RA prescription. We focused on GLP-1 RA initiators, analyzing only the first prescribed drug.

Results: We included 1,063,761 new GLP-1 RA users who were prescribed liraglutide (N=293,745), semaglutide (N=661,598), or tirzepatide (N=108,418) between January 1, 2016 and December 31, 2023. There were 591,139 (56%) enrollees with prevalent diabetes. Enrollees without any indication of diabetes were younger on average (mean±SD: 47±12) compared to those with a diabetes diagnosis (mean±SD: 54±11) and more likely to be female (76% vs. 55%, respectively). Mean CCI Score was lower among those without diabetes compared to those with diabetes (0.45 vs. 2.61). Since 2021, semaglutide has overtaken liraglutide as the most prescribed GLP-1 RA (Figure 1), regardless of diabetes status. Tirzepatide prescriptions have increased rapidly since their introduction in 2022.

Discussion: GLP-1 RA initiators without diabetes are more likely to be female and younger than those with diabetes. Semaglutide and tirzepatide use has increased dramatically since their approval for chronic weight management whereas the share of liraglutide prescriptions has plummeted. As these newer drugs gain popularity, contemporary data will be needed to track the evolving landscape of GLP-1 RA initiation patterns.