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Weight Maintenance Using Cost-Effective Antiobesity Medications After 1 Year of GLP-1 Receptor Agonist Therapy
TAKE-HOME MESSAGE
- In this study, the authors assessed the effectiveness of older-generation generic antiobesity medications (AOMs) in maintaining body weight after 1 year of GLP-1 receptor agonist therapy among 105 patients who had lost weight. Of the 105 patients, 40 transitioned to generic AOMs. After 12 months, this group lost an average of 18.3% of their body weight, with a mean BMI of 27.9 kg/m2, which was maintained at 18 months. Follow-up visits approximately 1.5 months later showed further weight loss, with an average total reduction of 25.5% from baseline weight.
- This study presents valuable insights into how older-generation AOMs can serve as a cost-effective strategy for sustaining weight loss achieved through GLP-1 receptor agonist–based pharmacotherapy. By exploring this approach, clinicians can enhance methods for long-term weight management.
abstract
This abstract is available on the publisher's site.
Access this abstract nowOBJECTIVE
The high cost of novel glucagon-like peptide-1 receptor agonist (GLP-1 RA) class agents often limits access and creates barriers to care. This real-world study evaluated the efficacy of older-generation generic antiobesity medications (AOMs) for weight maintenance after 1 year of GLP-1 RA therapy in patients who had achieved successful weight loss.
METHODS
We prospectively followed patients (N = 105) who had completed 12 months of therapy and were part of a "medical weight loss bundle," which included 12 months of GLP-1 RA therapy followed by 6 months of transition care. The baseline mean BMI was 36.4 kg/m2. Body weight outcomes were measured at 6, 12, 18, and 24 months.
RESULTS
After the medical weight loss bundle, 40 patients transitioned to generic AOMs. At 12 months, this cohort lost an average of 18.3%, 95% CI [13.0%, 23.6%] body weight from baseline, with a mean BMI of 27.9 kg/m2. At 18 months, they maintained the weight loss, with a mean BMI of 27.9 kg/m2. Subsequent follow-up visits (average 1.5 months later) without GLP-1 RAs showed further reduction, resulting in a total average weight loss of 25.5%, 95% CI [23.1%, 27.9%] compared to the initial visit.
CONCLUSIONS
Patients successfully treated with GLP-1 RAs can maintain their weight loss using generic older-generation AOMs, suggesting potential cost savings for insurers and implications for policy regarding AOM coverage.
Additional Info
Disclosure statements are available on the authors' profiles:
Weight maintenance on cost-effective antiobesity medications after 1 year of GLP-1 receptor agonist therapy: a real-world study
Obesity 2024 Dec 01;32(12)2255-2263, NU Paddu, B Lawrence, S Wong, SJ Poon, G SrivastavaFrom MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.
This prospective cohort study evaluated the effectiveness of older-generation generic antiobesity medications (AOMs) in weight loss maintenance in patients with at least class 2 obesity (BMI ≥35) who were enrolled in a medical weight loss bundle (MWLB) at Vanderbilt University Medical Center and achieved a BMI of less than 30 kg/m2 within 12 months of GLP-1 receptor agonist (GLP-1 RA) therapy. Patients who did not achieve a BMI of less than 30 kg/m2 within 12 months of the therapy were excluded. The population was primarily white (80.6%), female (92.1%), and middle-aged (average age, 45.2 years), with most of the participants having at least one weight-related comorbidity (75.2%).
The initial evaluation included 105 patients enrolled in the medical weight loss bundle, regardless of treatment completion or type of AOM used. Within 12 months, patients who achieved a BMI of less than 30 kg/m2 had an average BMI of 27.6 (95% CI, 27.6 ± 0.8) and an average total body weight (TBW) loss of 22.2% (95% CI, -22.2 ± 3.3). Patients who transitioned to primary care or specialist care maintained their weight loss at day 576 (n = 77: BMI, 95% CI 27.7 ± 0.6; TBW, 95% CI -25.2 ± 2.2%).
The second evaluation (n = 40) included patients who achieved A BMI of less than 30 kg/m2 after they started on GLP-1 RAs or GLP-1/GIP RAs, used either in combination with another AOM or as monotherapy for 12 months, and then were transitioned to older generation antiobesity agents (bupropion, naltrexone, phentermine, topiramate, and metformin) for weight maintenance. Within 12 months, patients achieved a mean BMI of less than 30 kg/m2 (n = 33; 95% CI, 27.9 ± 0.8) with an average TBW loss of 18.3% (95% CI, -18.3 ± 5.3). Patients who transitioned to solely an older AOM had maintained their weight loss at day 593 (n = 40; BMI, 95% CI 27.2 ± 0.9; TBW, 95% CI -25.5 ± 2.4%).
These data are useful but have several limitations. First, the findings are applicable to patients who were highly responsive to weight loss medications, resulting in an average weight loss greater than that reported in many trials (most patients were on semaglutide 2–2.4 mg doses, where the average weight loss at the maximum dose is 15%).1 This population had an excellent response to these medicines and may be more responsive to other forms of AOMs. Second, this study population was predominantly white, female, and middle-aged, which limits the generalizability of these findings; however, it may also represent a phenotype of patients more likely to be sensitive to these medicines.2,3 Third, although the most interesting findings were observed in the second evaluation, it had a small sample size (n = 40). Finally, there were missing data, as patient visits occurred at different times, and the sample size changed throughout each evaluation. For instance, the 24-month time point lacked useful data because of a very small sample size (n = 5 for study 1; n = 2 for study 2). Therefore, earlier time points had to be used (576 days for study 1 and 593 days for study 2) to make the data useful.
Despite these limitations, these data suggest that patients who exhibit a robust response to GLP-1/GIP RA therapy may be able to transition to older-generation antiobesity agents while maintaining their weight loss. However, because the generalizability of this study is limited, these results should not be applied to every case.
References