麻豆传媒

In this video interview, Hamlet Gasoyan, PhD, staff investigator at the Cleveland Clinic's Center for Value-Based Care Research, discusses his in JAMA Network Open that looked at the weight outcomes and factors associated with clinically meaningful weight loss at 1 year among patients with obesity receiving the GLP-1 agonists semaglutide (Ozempic, Wegovy) and liraglutide (Victoza, Saxenda).

The following is a transcript of his remarks:

Recently, GLP-1 receptor agonist medications have been prescribed more commonly, in part due to their ability to produce clinically significant weight loss.

And we know we have the randomized controlled trial data with robust efficacy, but outside of randomized controlled trial data, the real-world weight outcomes data are either limited to short-term follow-up based on cohorts that excluded patients who were not persistent with these medications or based on brand names that have been approved only for the treatment of type 2 diabetes.

Now, we also recently documented that achieving persistent coverage with these medications for the treatment of obesity could be challenging, but we did not know how this affected our longer-term weight outcomes.

So having all this in mind, we designed this study to look at longer-term weight outcomes in patients with obesity who received injectable semaglutide or liraglutide, either for obesity or type 2 diabetes, and also examined some of the key factors that could predict clinically meaningful weight loss at 1 year.

We did a multivariable analysis where we looked at independent predictors, meaning that we adjusted for other relevant confounders. And in this multivariable analysis, we saw that there are key predictors of achieving 10% or more weight loss, including patients who received semaglutide versus liraglutide, patients who received the higher dosage of these medications compared to lower dosage, those who received the medication for the treatment of obesity versus type 2 diabetes, and those who were persistent with the medication compared to those who were not.

Also, we saw that female sex was associated with higher odds of achieving 10% or more weight loss, and higher initial body mass index was associated with higher odds of achieving 10% or more weight loss at 1 year.

We know that patients might have very high expectations of achieving considerable weight loss with these medications. What our real-world data show, first, it provides timely data on longer-term outcomes with these medications, but also it provides some realistic expectations for patients to know what to expect. And also, while experts in the field might know all these factors, patients who receive their information from popular press might not be aware that there are key factors that could predict their probability of achieving 10% or more -- or in other words, clinically meaningful -- weight loss. So that would be helpful in terms of managing expectations.

In terms of clinicians, it could help them guide their conversations with patients about these medications and the importance of persisting with medications to achieve weight loss that has been observed in randomized controlled trials.

And a third point I think is important is that our study also identifies the challenges of treating diabetes and obesity with these highly effective medications, as only four in 10 patients in our study had persistent coverage with these medications at 1 year. So this also identifies issues that need to be addressed moving forward, because as we can see, there's some unrealized potential that could be realized if there are effective interventions to improve persistence with these medications.

My recommendation in terms of future research would be trying to understand what's happening. What are the barriers for patients in terms of having coverage gaps, and then what could be done about it? So we need more research in terms of understanding these issues.

And then once we have a little bit better understanding of this, we could move forward with designing interventions and trying to address this. Because if you want to have high-quality and high-value care delivered to the patients who need these medications, our data show that they need to be receiving these medications without interruptions. That would be a key step moving forward.

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