Did the SCALE 2015 trial and the SCALE prediabetes trial for liraglutide (Victoza) investigate rates of weight regain after discontinuation and continuation of lifestyle management?

Weight Regain and Lifestyle Management After Liraglutide Discontinuation in SCALE Trials

The SCALE trials did not specifically report on weight regain patterns after liraglutide discontinuation or whether patients continued lifestyle management after stopping the medication.

SCALE Trials Overview and Weight Loss Findings

The SCALE (Satiety and Clinical Adiposity - Liraglutide Evidence) trials were key studies evaluating liraglutide 3.0 mg for weight management:

• SCALE Obesity and Prediabetes (2015): Demonstrated mean weight loss of 8.4 kg with liraglutide versus 2.8 kg with placebo over 56 weeks 1
• SCALE Prediabetes (3-year extension): Showed sustained weight loss of 6.1% with liraglutide versus 1.9% with placebo over 160 weeks 2
• SCALE Diabetes: Demonstrated 6.0% weight loss with liraglutide 3.0 mg versus 2.0% with placebo over 56 weeks 3

Absence of Weight Regain Data After Discontinuation

The available evidence from the SCALE trials does not specifically address:

1. The rate or pattern of weight regain after discontinuation of liraglutide
2. Whether participants continued lifestyle modifications after stopping the medication

What We Know About GLP-1 RA Discontinuation

While the SCALE trials don't directly answer your question, other evidence suggests:

• Long-term use of GLP-1 receptor agonists is necessary to maintain weight loss, as significant weight regain occurs after discontinuation 4
• Weight regain of approximately 11.6% of lost weight occurs after stopping semaglutide (another GLP-1 RA) 4

Lifestyle Management During SCALE Trials

During the active treatment phase of the SCALE trials:

• All participants (both liraglutide and placebo groups) received counseling on lifestyle modification 1
• Participants followed a 500 kcal/day energy-deficit diet and increased physical activity throughout the trials 5
• Most studies emphasized a hypocaloric diet with at least 500-kcal energy deficit below individualized daily caloric requirements, along with 150 min/week of physical activity 6

Clinical Implications

Based on the available evidence:

• Liraglutide 3.0 mg is effective for weight management when used with lifestyle interventions, with mean weight loss of 4.81% greater than placebo 6
• The AGA suggests using liraglutide 3.0 mg with lifestyle interventions for adults with obesity or overweight with weight-related complications (conditional recommendation, moderate certainty) 6
• For optimal outcomes, liraglutide should be considered a chronic therapy rather than a short-term intervention, as weight regain is likely after discontinuation 4

Common Pitfalls and Caveats

• Discontinuation without planning: Stopping GLP-1 RAs without a maintenance strategy likely leads to weight regain
• Overlooking lifestyle components: The medication works best when combined with dietary changes and physical activity
• Unrealistic expectations: Patients should understand that weight maintenance requires ongoing effort even with medication
• Inadequate monitoring: Regular follow-up is essential to assess efficacy and manage side effects

For patients considering discontinuation of liraglutide, maintaining the lifestyle modifications established during treatment would be logical to minimize weight regain, though specific evidence from the SCALE trials on this point is lacking.