Abstract Body: Introduction: Real-world data reveal long-term persistence with GLP-1 Receptor Agonists (RAs) is low. This study examines GLP-1 RA prescription trends and the association between socioeconomic, demographic, and clinical factors with treatment persistence.
Methods: Adults (age 18+) prescribed GLP-1 RAs between January 2010 and October 2023 were identified from the All of Us Research Program (electronic health records). We analyzed yearly distributions of primary condition prior to GLP-1 RA therapy, new user trends, sociodemographic characteristics (age, sex at birth, race, ethnicity, insurance, income, education and body mass index/BMI), and GLP-1 RA persistence at 3, 6, and 12 months. We defined persistence as continuous GLP-1 RA use, allowing a prescription gap of up to 60 days and GLP-1 RA class switching. Persistence rates were stratified by sociodemographic and clinical factors, with statistical analyses performed using chi-squared tests and multivariable logistic regression.
Results: Drug prescription preference changed from Liraglutide and Dulaglutide to Semaglutide and Tirzepatide over time. GLP-1 RA use was highest among middle-aged women while spanning broad socioeconomic strata. Persistence rates at 3, 6 and 12 months were 71.0%, 55.6% and 38.0% respectively. Persistence varied across age, sex, ethnicity, insurance type, and condition at GLP-1 initiation (P<0.001). At 12 months, patients aged 18-39 had the lowest persistence (27.3%) with adjusted odds ratios (aOR) significantly different from those in the 40-64 age group (P <0.001). Men were more persistent than women (44.6% vs 34.8%; aOR 1.28 [95% CI: 1.18-1.37]); Medicare patients had the highest persistence while those with private insurance had the lowest (42.0% vs 34.7%; aOR 1.23 [95% CI: 1.11-1.35]); and patients with T2D present at GLP-1 RA initiation showed higher persistence compared to those with obesity but without T2D (46.3% vs 23.3%; aOR: 2.70 [95% CI: 2.50-2.94]). Race and education showed little association with persistence, while income and body mass index no association with persistence.
Conclusion: GLP-1 RA persistence declines across all groups over time, with higher discontinuation among younger adults, women, privately insured individuals, and those with obesity but without diabetes. These findings may guide future efforts at improving long-term GLP-1 RA persistence, addressing issues such as side effects, lack of desired effect, and cost.