What percentage of patients remain on Glucagon-like peptide-1 (GLP-1) receptor agonists long term?

Long-Term Adherence to GLP-1 Receptor Agonists

Real-world data demonstrates that 20-50% of patients discontinue GLP-1 receptor agonists within the first year, with approximately half of all patients failing treatment by 42 months (3.5 years). 1, 2

Discontinuation Rates and Persistence

First-Year Discontinuation

• High discontinuation rates of 20-50% occur within the first 12 months of GLP-1 receptor agonist therapy 1
• Only 6.3% of patients with diabetes and CKD demonstrated persistent use for at least 90 days in the CURE-CKD Registry (2019-2020) 3
• Treatment failure was observed in 51% of patients after a mean duration of 50 months, with half of all patients failing by 42 months 2

Long-Term Persistence Beyond One Year

• After 4 years of treatment, beneficial effects on HbA1c are maintained in only approximately one-third of patients 2
• Patients on long-acting GLP-1 receptor agonists who remained on therapy chronically had a median treatment duration of 57 months (approximately 4.75 years) 3

Factors Affecting Adherence

Medication Formulation Impact

• Weekly GLP-1 receptor agonists demonstrate significantly better adherence than daily formulations (proportion of days covered ≥80%: OR 1.25,95% CI 1.21-1.28) 4
• Good adherence (≥80% of days covered) is more frequently achieved with once-weekly preparations compared to daily dosing (82.4% vs. 74.7%) 4

Predictive Factors for Treatment Failure

• Baseline HbA1c >9.0% is a strong predictor of treatment failure 2
• Male gender predicts higher treatment failure rates 2
• Better adherence is associated with: older age, female gender, Jewish ethnicity, and higher socioeconomic status 4

Real-World Dosing Patterns

Suboptimal Dosing

• Real-world studies demonstrate use of much lower doses than those evaluated in clinical trials 1
• This suboptimal dosing contributes to reduced effectiveness compared to randomized controlled trial outcomes 1

Clinical Implications

Weight and Glycemic Outcomes Over Time

• HbA1c improvement is most pronounced during the first year (-1.2%), with effects maintained at 4 years (-1.4% vs. baseline) in those who persist 2
• At 1 year, only 26% of patients achieve HbA1c <7.0% and 47% achieve <7.5% 2
• BMI decreases by -0.9 kg/m² in the first year and -1.9 kg/m² after 4 years in persistent users 2

Common Reasons for Discontinuation

• Gastrointestinal side effects (nausea, vomiting, diarrhea) are the primary drivers of early discontinuation 1, 5, 6
• High medication costs, especially when not covered by insurance, contribute significantly to discontinuation 1
• These gastrointestinal adverse effects are dose-dependent and more common with short-acting than long-acting formulations 5, 6

Implementation Barriers

Healthcare System Utilization

• As recently as 2020, only 17% of patients with commercial health insurance who had diabetes and CKD initiated GLP-1 receptor agonists 3
• Similar slow uptake was observed in the VA health system 3
• High medication costs remain a major barrier to implementation and sustained use 3