Real‐world titration, persistence & weight loss of semaglutide and tirzepatide in an academic obesity clinic
Jason M. Samuels, Fei Ye, Rebecca Irlmeier, Heidi Silver, Gitanjali Srivastava, Matthew SpannAbstract
Aims
Trials of the Glucagon‐like Peptide‐1 Receptor Agonists (GLP1RAs) found mean weight losses of 15%–21%, yet realworld dose titration and persistence remain suboptimal, limiting effectiveness. This study aims to determine real‐world titration, persistence and effectiveness of GLP1RAs in patients managed within a multidisciplinary obesity clinic.
Materials and Methods
This is a singlecentre, retrospective cohort study of patients seen in a multidisciplinary obesity clinic at an academic medical centre from January 2022 to December 2024. Consecutive patients aged 18–75 years enrolled in a ‘no cost to patient’ Medical Weight Loss Bundle program who received ≥1 prescription fill of semaglutide or tirzepatide. Of 2855 enrollees, 2306 (81%) received at least one GLP1RA prescription. The primary outcome was persistence with GLP1RA therapy (continuous prescription fills without a gap ≥84 days). Secondary measures included titration adherence and percentage change in body weight.
Results
Among 2306 patients (median age 46.0 years, Interquartile Ratio [IQR] 38.0–55.0; 85% female; 68% White, 28% Black, 4% Hispanic), with median persistence 10.7 months (IQR 5.4–16.3). Semaglutide was used by 1614 (70%), tirzepatide by 117 (5%), and both agents by 575 (25%). Of semaglutide users, 81% escalated to ≥1 mg and 23% to 2.4 mg; of tirzepatide users, 75% received ≥10 mg and 28% received 15 mg. Among patients persistent for ≥6 months, median weight loss was 9.4% (IQR 6.0%–13.4%); for those persistent for ≥12 months, median weight loss was 14.4% (IQR 9.5%–20.5%).
Conclusions
GLP1RA persistence and dosetitration adherence were moderate but weight loss approximated that seen in clinical trials, supporting real‐world effectiveness.