Trends and Disparities in Newer GLP1 Receptor Agonist Initiation among Real-World Adult Patients Eligible for Obesity Treatment

No SJR dataFeb 20, 2025medRxiv : the preprint server for health sciences

Patterns and Differences in Starting Newer GLP-1 Medicines for Adults Eligible for Obesity Treatment

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Abstract

Only 1.8% of 319,949 adults initiated newer anti-obesity medications.

Semaglutide was the most commonly initiated medication, accounting for 77.9% of cases.
Tirzepatide and liraglutide had initiation rates of 19.7% and 17.8%, respectively.
Liraglutide initiation peaked at 5% in 2018 but declined afterward.
Semaglutide and tirzepatide uptake significantly increased since 2022.
Lower initiation odds were observed for Black and Hispanic individuals compared to White individuals.
Medicaid and uninsured patients showed lower initiation odds compared to those with private insurance.

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AIMS: To characterize trends in the initiation of newer anti-obesity medications (AOMs) and determine factors associated with their use among obese/overweight populations.

MATERIALS AND METHODS: This retrospective study utilized electronic health record data from OneFlorida+ (2015-2024). Adults eligible for AOMs were included, defined as having a BMI ≥30 kg/m² or a BMI of 27-29.9 kg/m² with at least one obesity-related comorbidity. The primary outcome was the initiation of newer AOMs, specifically glucagon-like peptide-1 receptor agonists (GLP-1 RAs) including liraglutide, semaglutide, and tirzepatide. Trends across years were examined, and a multivariable logistic regression identified sociodemographic, clinical, and healthcare utilization factors associated with AOM initiation.

RESULTS: Of 319,949 adults, 1.8% initiated newer AOMs. Semaglutide accounted for 77.9% of initiations, tirzepatide 19.7%, and liraglutide 17.8%. Initiation trends showed liraglutide uptake peaked at 5% in 2018 but declined afterward, while semaglutide and tirzepatide uptake increased exponentially since 2022. Odds of initiation were lower for Black (aOR (95% CI): 0.87 [0.80- 0.94]) and Hispanic (0.84 [0.78-0.91]) groups vs. Whites, and for Medicaid (0.69 [0.63-0.76]) and uninsured (0.81 [0.74-0.87]) patients vs. privately insured. Higher odds were associated with being female, middle-aged, having more outpatient visits, and visiting endocrinologists.

CONCLUSIONS: The initiation of newer AOMs among overweight and obese populations remains low, but uptake has increased exponentially since 2022. Our findings reveal significant disparities in obesity care, highlighting the importance of addressing inequities in AOM access to improve obesity outcomes.

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