Surge in New GLP-1 Prescriptions Driven by Semaglutide's Popularity, Study Shows

Ali Rezaie, MD
Credit: Cedars-Sinai

New research leveraging records from more than 40 million US patients is shedding light on the magnitude of the recent boom in demand for GLP-1 receptor agonists, namely semaglutide (Ozempic; Wegovy).

An analysis of data recorded between 2011 and 2023 from the TriNetX database, results indicate more than 800,000 patients became new users of GLP-1 receptor agonists during the period, with a marked increase in use beginning in 2020 as weight loss benefits began to emerge. According to the data, interest in semaglutide also ballooned in this period, with the agent accounting for more than 88% of new GLP-1 receptor agonist prescriptions in 2023.¹

“Essentially, after the medication was approved for obesity, GLP-1RA use took off so quickly that we lost control and vision of how fast people were picking up these medications, and the trends of use are uncertain,” said Ali Rezaie, MD, medical director of the Cedars-Sinai GI Motility Program and director of bioinformatics at the Medically Associated Science and Technology program at Cedars-Sinai.² “While GLP1-RAs offer several benefits, they are also associated with various common and uncommon side effects, necessitating careful monitoring of their prescription patterns.”

Seemingly in tandem, the recognition of obesity as a disease and the craze over GLP-1 receptor agonists has come to the forefront of discussions in recent years. This is, in large part, due to the growing burden the obesity crisis has placed on individuals as well as public health systems.

Although the seeds for this storm of awareness and demand for GLP-1 receptor agonists were sown in years prior, the floodgates were opened in 2021 when semaglutide became the first agent in nearly a decade to receive an indication from the US Food and Drug Administration for chronic weight management. This demand has only intensified as newer incretin-based therapies, such as tirzepatide (Mounjaro; Zepbound), have emerged with the potential of an even greater magnitude of weight loss and glycemic control.^1,2,3

With all this in mind, Rezaie and a team of colleagues from Cedars-Sinai sought to evaluate nationwide trends in GLP-1 receptor agonists prescription patterns, with a specific interest in assessing trends by indications, from within the TriNetX database. With their period of interest defined as 2011 through 2023, investigators obtained information from 45,587,908 individuals with at least 1 outpatient visit during the study period.¹

Among the more than 45 million included in the study, 871,854 received a new prescription for a GLP-1 receptor agonist. When stratified into time periods, the total number of new GLP-1 receptor agonists grew throughout the period, with 27,367 new prescriptions from 2011 to 2014, to 131,029 new prescriptions from 2015 to 2018, and up to 679,265 new prescriptions from 2019 to 2023.¹

Initial analysis of new GLP-1 receptor agonist users suggested these patients were disproportionately female (59.6% vs 35.5%), non-Hispanic White (68.7%), and persons with a BMI of 30 kg/m2 or greater (63.5%). Further analysis revealed evidence of an increasing age- and sex-standardized incidence of new GLP-1 receptor agonist us during the study period, with a notable increase after 2020.¹

Investigators pointed out analyses stratified according to indication demonstrated a decreasing trend in portion of new use for type 2 diabetes, but a more than doubling in the proportion of users without type 2 diabetes but with a BMI of 30 kg/m2 or greater, or in those with a BMI of 27 to 30 kg/m2 and an obesity-related comorbid condition. Investigators noted the proportion of new off-label users also increased from 0.21% in 2019 to 0.37% in 2023.¹

Investigators also highlighted the relative rise in popularity of semaglutide in recent years. According to results, semaglutide accounted for 31.4% of new GLP-1 receptor agonist prescripts in 2019, with the most common being liraglutide at 35.3%. In 2023, semaglutide accounted for 88.1% of new GLP-1 receptor agonist prescriptions compared to 10.3% for liraglutide.¹

Investigators called attention to multiple limitations within their study. These included being limited to those included in TriNetX,lack of information surrounding indications for off-label use, and missing data on BMI for approximately 3% of the cohort.¹

“This data suggests that more healthcare providers are seeing the benefits of these medications for treating obesity, which is a significant public health shift,” said study investigator Yee Hui Yeo, MD, a clinical fellow in the Karsh Division of Gastroenterology and Hepatology at Cedars-Sinai.² “However, it also raises concerns about potential medication shortages and the need to ensure that patients with diabetes still have access to these treatments.”

References:

1. Yeo YH, Rezaie A, Hsieh TY-J. Shifting Trends in the Indication of Glucagon-like Peptide-1 Receptor Agonist Prescriptions: A Nationwide Analysis. Annals of Internal Medicine. Published online July 22, 2024. doi:10.7326/M24-0019
2. Martinez C. New Cedars-Sinai study investigates shifting trends in GLP-1RA prescription. EurekAlert! July 22, 2024. Accessed July 22, 2024. https://www.eurekalert.org/news-releases/1051902.
3. Campbell P, Iapoce C. 10 years of obesity: A Decade of Advancement and challenges. HCP Live. June 23, 2023. Accessed July 22, 2024. https://www.hcplive.com/view/10-years-of-obesity-a-decade-of-advancement-and-challenges.