758-P: Titration to Maintenance Doses of GLP-1R Agonists for Overweight and Obesity Is Suboptimal for Majority of Patients—Evidence from a Real-World Claims Dataset

by sugaradmin



Introduction and Objective: Glucagon-like peptide-1 receptor agonists (GLP-1RAs) represent a paradigm shift in treating obesity. The substantial weight loss observed in clinical trials improves weight-related comorbidities. However, weight loss reported in the real world has been less than that seen in clinical trials. One hypothesis for this gap is that patients may not complete the complex multistep titration required to reach the higher maintenance doses associated with maximal benefit. This study aimed to assess the real-world practice of titration and quantify the percentage of patients who achieve maintenance dosing.Methods: We used the Komodo US claims administrative dataset to identify a cohort of adults with at least 1 claim for initiation dose (0.25 mg) of the GLP-1RA semaglutide SC indicated for weight loss (by NDC) from Jun 2021-Aug 2023. Patients were assessed for claims for escalation and maintenances doses of semaglutide between Jun 2021-Aug 2024 using 35- and 70-day windows for dose increases, as well as having a claim for a maintenance dose at any point during follow-up.Results: Data from 655,419 patients were included. Most (80%) were female, and 81% had commercial insurance. When considering 35-day titration, a significant drop-off was observed with each step, with 19% reaching a 1.7 mg dose and 15% reaching a 2.4 mg dose. Over a slower, 70-day titration schedule, 31% and 24% achieved 1.7 and 2.4 mg, respectively. At any point during follow-up, 50% had a claim for 1.7 mg and 40% for 2.4 mg.Conclusion: Fewer than half of patients initiating semaglutide for weight loss ever receive the top maintenance dose studied in pivotal trials and associated with the greatest clinical benefit. This suggests that the complex multistep titration scheme presents implementation challenges in real-world practice that may limit its effectiveness at delivering optimal weight loss and improved health outcomes.

Disclosure

S. Armstrong: Employee; Metsera. L. Mostovoy: Consultant; Metsera. G. Gaich: Employee; 89bio, Inc. Stock/Shareholder; 89bio, Inc. Employee; Metsera, Inc. M.A. Noor: Employee; Metsera, Olatec.



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