REAL-WORLD WEIGHT LOSS OUTCOMES OF SEMAGLUTIDE: COMPARATIVE ANALYSIS AMONG PATIENTS WITH AND WITHOUT METABOLIC/BARIATRIC SURGERY

Background: Introduction of Nutrient Stimulated Hormone-based agents such as semaglutide, a glucagon-like peptide-1 receptor agonist (GLP-1), have revolutionized weight management strategies given their excellent weight loss outcomes in trials settings. There are, however, several real-world challenges with the use of these medications including cost, medication shortage, side effects, and others. The weight loss outcomes of these medications in those with a past history of Metabolic/Bariatric Surgery (MBS) are not well known. In this study, we aimed to discover weight loss outcomes of semaglutide in real-world practice among surgical and non-surgical patients.
Methods: We conducted a retrospective cohort study of patients who were prescribed semaglutide in our institutional weight management center between 2018 and 2023. The percentage total weight loss (%TWL) was analyzed for the overall cohort using our electronic health records, and a detailed chart review was performed on a 20% subgroup to assess for medication compliance. Those with or without a history of MBS were compared.
Results: Among 2,491 patients prescribed semaglutide (78% female, 73.5% white, and mean age 50.9±12.9 years), 330 (13.2%) had a history of MBS. In the overall cohort, TWL% was 6%. Individuals with and without MBS had a TWL% of 5.8% and 6% (p=.3), respectively, over a mean follow-up of 59.2 and 52.4 weeks (p=.02). Notably, within the non- MBS subgroup, females exhibited a higher weight reduction compared to males (6.4% vs. 4.8%, p<.001). Table 1 summarizes a cohort of 500 patients with a detailed chart review. Among them, 75 (15%) patients were not able to commence medication primarily due to lack of insurance. 100 (20%) patients had to discontinue the medication predominantly due to side effects. The remaining cases were consistently using the medication at the last follow-up visit attained an average %TWL of 8.5% over 50.3 weeks.
Conclusions: This study highlights the lack of insurance coverage as one of the most common burdens for patients to start semaglutide. Even in patients with a prior MBS history, semaglutide leads to meaningful weight loss similar to those without MBS history, although overall, these results are lower than those achieved in clinical trials.