Semaglutide discontinuation more common in patients with diabetes plus stroke, CKD
A study of older adults with diabetes who initiated a glucagon-like peptide-1 receptor agonist found that, in the U.S., more than half had discontinued it within a year, with higher discontinuation rates among those with chronic kidney disease (CKD), a history of stroke, or peripheral vascular disease.
Diabetes patients with stroke or chronic kidney disease (CKD) were more likely to discontinue glucagon-like peptide-1 (GLP-1) receptor agonists after 12 months than those without those conditions, a study in the United States and Japan found.
Researchers used national health care databases from each country to evaluate frequency and predictors of discontinuation of injectable semaglutide. All individuals were ages 65 years or older, had diabetes, and filled injectable semaglutide prescriptions. A total of 318,543 U.S. patients (mean age, 71.7 years; 55% female) and 8,531 Japanese patients (mean age, 77.3 years; 49.8% female) were included. Findings were published by JAMA Cardiology on Sept. 24.
One year after initiation, 59.5% of U.S. patients and 30.8% of Japanese patients had discontinued use of any GLP-1 receptor agonist; 2.8% of U.S. patients and 10.1% of Japanese patients had switched to oral semaglutide or another GLP-1 receptor agonist. Discontinuation rates were higher in patients with pre-existing chronic kidney disease (2.27 percentage points [95% CI, 1.73 to 2.82] in the U.S. and 6.22 percentage points [95% CI, 4.21 to 8.24] in Japan), stroke (1.94 percentage points [95% CI, 1.29 to 2.59] in the U.S. and 2.84 percentage points [95% CI, 0.34 to 5.34] in Japan), or peripheral vascular disease (1.57 percentage points [95% CI, 1..08 to 2.07] in the U.S. and 5.49 percentage points [95% CI, 0.31 to 10.67] in Japan). Compared with patients enrolled in Medicare alone, discontinuation was less frequent in individuals dually enrolled in Medicare and Medicaid (−11.89 percentage points [95% CI, −12.32 to −11.46]).
The study did not assess specific reasons for discontinuation, although researchers hypothesized that medication intolerance, out-of-pocket costs, and drug stockouts may be potential drivers.
Limitations of the study include a lack of information on out-of-pocket costs. The findings may not be generalizable to patients without diabetes, younger populations, or individuals initiating oral semaglutide, the authors cautioned.
“The high frequency of discontinuation in 2 countries with structurally different health care systems and differing burdens of cardiometabolic conditions highlights the need for concerted global efforts to support persistence with semaglutide, particularly among populations at high risk,” they concluded.