Adults with Obesity Who Receive Semaglutide as First Weight Loss Medication Lose More Weight

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Adults with a history of antiobesity medication (AOM) use before receiving semaglutide for weight loss lost less body weight than those who were AOM-naïve, according to a recent study published in Diabetes, Obesity and Metabolism.

“To our knowledge, this is the first study assessing the association between previous use of anti-obesity medications and the weight loss outcomes of patients prescribed semaglutide for treatment of overweight or obesity,” Andres J. Acosta, MD, PhD, assistant professor of medicine, Mayo Clinic, Rochester, Minnesota, and colleagues wrote in the study published online March 12, 2024.

Study participants who were naïve to AOM achieved greater loss of body weight 3, 6, 9 and 12 months when compared to those who had taken a different AOM in the past, researchers added. The overall efficacy of the medication for both groups, however, was demonstrated by clinically significant total body weight loss (TBWL) among similar proportions of 5% or more and 10% or more at 12 months, they reported.

Acosta and colleagues conducted a retrospective cohort study using data from Mayo Clinic Hospital centers and affiliated hospitals between January 2021 and 2023 to compare the weight loss outcomes associated with semaglutide treatment between patients who had previously received another AOM (non-AOM-naïve) and those who were AOM-naïve.

Participants included adults with a body mass index (BMI) of at least 27 kg/m2 who received weekly subcutaneous semaglutide injections for the primary purpose of weight loss. The primary endpoint was 12-month TBWL in AOM-naïve compared to non-AOM-naïve participants. The secondary outcome was a comparison of the proportion of participants achieving ≥5%, ≥10%, ≥15%, and ≥20% TBWL between the groups, according to the study.

A total of 305 patients (mean age, 49 years; 73% women) were included in the analysis, of whom 231 (75%) were AOM-naïve and 74 (24%) were non-AOM-naïve. Mean baseline BMI was 41 kg/m². Comorbidities among the cohort included hypertension (48%), dyslipidemia (48%), obstructive sleep apnea (34%), gastroesophageal reflux disease (30%), and type 2 diabetes (26%).

Among the participants who had previously taken an AOM, 28% had used liraglutide and 72% reported taking a non-GLP-1 AOM.

FINDINGS

Results showed that TBWL was greater among AOM-naïve participants compared with non-AOM-naïve participants at:

• 3 months (mean, 6.3% vs 3.8%; P < .001)
• 6 months (mean, 10.6% vs 6.7%; P < .001)
• 9 months (mean, 14.0% vs 9.1%; P < .001)
• 12 months (mean, 14.3% vs 10.6%; P = .01)

Investigators also found that compared with non-AOM-naïve participants, a greater proportion of AOM-naïve participants achieved TBWL at 12 months of ≥15% (48.0% vs 21.0%; P < .05) and ≥20% (27.0% vs 4.0%; P < .01).

Acosta and colleagues reported lower levels of TBWL among AOM-experienced participants who had previous exposure to GLP-1 receptor agonists than those who did not at the 3, 6, 9, and 12-month points.

“[I]n this study, the use of semaglutide in patients with previous intake of other AOMs was associated with inferior weight loss outcomes in comparison to AOM-naïve patients,” researchers noted. “These data are crucial for physicians and patients to manage expectations and guide therapy based on targeted weight loss goals.”

Reference: Ghusn W, Fansa S, Anazco D, et al. The association between previous use of anti-obesity medication and semaglutide weight loss outcomes. Diabetes Obes Metab. Published online March 12, 2024. doi:10.1111/dom.15523