From the Guidelines
Patients taking GLP-1s like semaglutide and tirzepatide for weight loss are likely to experience some weight regain if switched to liraglutide, as liraglutide is generally less potent for weight loss than newer GLP-1 medications. This is primarily because liraglutide has a shorter half-life requiring daily dosing and acts primarily on GLP-1 receptors, whereas semaglutide has a longer half-life allowing weekly dosing 1. According to a recent review published in JAMA, subcutaneous semaglutide reduced weight and improved weight-related comorbidities significantly more than liraglutide and was associated with lower rates of gastrointestinal adverse events 1.
The difference in efficacy between these medications relates to receptor activity profiles and half-life differences. Liraglutide has been shown to achieve a mean weight loss of 8.0% at 56 weeks, compared to 14.9% and 16.0% with semaglutide in the STEP 1 and STEP 3 trials, respectively 1. If a switch to liraglutide is necessary due to insurance coverage or other factors, patients should be counseled about potential weight regain and the importance of maximizing lifestyle modifications, such as following a reduced-calorie diet and participating in regular physical activity. The maximum dose of liraglutide for weight management is 3 mg daily, which should be reached through gradual titration to minimize gastrointestinal side effects.
Key points to consider when switching to liraglutide include:
- Liraglutide is generally less potent for weight loss than semaglutide and tirzepatide
- Patients may experience some weight regain when switching to liraglutide
- Maximizing lifestyle modifications is crucial to maintaining weight loss
- Gradual titration of liraglutide is necessary to minimize gastrointestinal side effects
- The maximum dose of liraglutide for weight management is 3 mg daily 1.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Studies on GLP-1RAs for Weight Loss
- The studies 2, 3, 4, 5 discuss the efficacy and safety of GLP-1RAs, including semaglutide and tirzepatide, for weight loss in various populations.
- However, there is limited information on whether patients taking semaglutide or tirzepatide for weight loss can maintain weight if switched to liraglutide.
Discontinuation of GLP-1RA Treatment
- A systematic review and meta-analysis 6 found that discontinuing GLP-1RA treatment leads to significant weight regain, with participants taking liraglutide regaining 2.20 kg and those taking semaglutide/tirzepatide regaining 9.69 kg.
- The study suggests that the proportion of weight regained is proportional to the amount originally lost, and that discontinuation of GLP-1RA treatment should be considered a chronic therapy to prevent weight regain and associated undesirable outcomes related to obesity.
Switching from Semaglutide or Tirzepatide to Liraglutide
- There is no direct evidence from the provided studies on the effectiveness of switching from semaglutide or tirzepatide to liraglutide for maintaining weight loss.
- However, the study 6 suggests that liraglutide may be associated with less weight regain compared to semaglutide/tirzepatide after discontinuation of treatment, but this does not necessarily imply that switching from semaglutide or tirzepatide to liraglutide would be effective for maintaining weight loss.