Should she continue taking Wegovy (semaglutide)?

Continuing Wegovy (Semaglutide) for Weight Management

Patients who achieve sufficient early weight loss (>5% after 3 months) should continue Wegovy (semaglutide) long-term, as discontinuation leads to significant weight regain. 1

Efficacy Assessment

The decision to continue Wegovy should be based on a structured assessment of efficacy:

• First 3 months: Assess monthly for efficacy and safety 1
• After 3 months: Assess quarterly 1
• Decision point: If weight loss is ≥5% after 3 months, continue therapy 1, 2
• Warning sign: If weight loss is <5% after 3 months, discontinuation should be considered as continued use is unlikely to improve outcomes 1

Safety Monitoring

Regular monitoring is essential while continuing Wegovy:

• Gastrointestinal effects: Most common side effects include nausea, vomiting, diarrhea, and esophageal reflux 1, 3
• Pancreatitis: Discontinue if pancreatitis is suspected 1
• Thyroid monitoring: Black box warning for risk of thyroid C-cell tumors in rodents (human relevance not determined) 1, 3
• Renal function: Use caution in patients with kidney disease due to potential risk of acute kidney injury 1
• Gallbladder disease: Monitor for symptoms of cholelithiasis 1, 2

Contraindications

Do not continue Wegovy in patients with:

• Personal or family history of medullary thyroid carcinoma 2, 3
• Multiple Endocrine Neoplasia syndrome type 2 2, 3
• Pregnancy or planning pregnancy 1, 2
• Women of reproductive potential must use reliable contraception 1

Long-Term Maintenance

For successful long-term maintenance:

• Dosing: Continue at the maintenance dose of 2.4 mg weekly 2
• Duration: Long-term therapy is recommended as studies show significant weight regain with discontinuation 2
• Combination approach: Continue lifestyle modifications alongside medication 1
• Regular follow-up: Quarterly assessment after the initial 3 months 1

Special Considerations

• Diabetes management: Semaglutide provides additional benefits for glycemic control in patients with type 2 diabetes 1
• Cardiovascular benefits: Semaglutide has demonstrated cardiovascular safety in dedicated outcome trials 1
• Pre-treatment assessment: Ensure proper screening for thyroid abnormalities, pancreatitis history, and other contraindications 4

Pitfalls to Avoid

• Abrupt discontinuation: Results in regain of 50-67% of weight loss within one year 2
• Inadequate monitoring: Failure to assess for potential complications like pancreatitis or gallbladder disease 4
• Ignoring contraindications: Especially important for thyroid cancer risk and pregnancy 2, 3
• Unrealistic expectations: Weight loss plateaus are normal; continuing therapy maintains rather than continuously increases weight loss 2

Remember that Wegovy is intended for chronic use in obesity management, similar to medications for other chronic conditions. Discontinuation typically leads to weight regain, undermining the health benefits achieved.