GLP-1 receptor agonists are powerful medications used to treat obesity. These medicines, such as semaglutide, liraglutide, and tirzepatide, help people lose weight by reducing appetite and slowing how quickly food leaves the stomach. They have changed the way obesity is treated. But one important question remains: how long do people stay on these medications?
A new study published in JAMA Network Open looked at real-world patterns of switching and staying on GLP-1 medications in adults with overweight or obesity who did not have diabetes. The findings offer important insights into how these treatments are actually used in everyday care.
How the Study Was Done
Researchers conducted a large retrospective cohort study. This means they looked back at existing medical insurance claims data rather than enrolling patients in a new trial. The data came from a Commercial Claims and Encounters Database, which includes information from about 40 million insured individuals in the United States each year.
The study included 126,984 adults who started a GLP-1 medication between 2019 and 2024. All participants had overweight or obesity and did not have diabetes. To be included, patients had to be continuously insured for 12 months before and 12 months after starting their medication.
Researchers divided patients into two groups:
- Switchers: People who changed from one GLP-1 medication to another within 12 months
- Nonswitchers: People who stayed on their original GLP-1 medication
The study measured two important outcomes:
- Persistence: Staying on any GLP-1 medication continuously for 12 months, allowing gaps of up to 60 days
- Adherence: The proportion of days covered (PDC), which measures how often patients had medication available. A PDC of 80% or higher was considered good adherence.
Fewer Than 1 in 4 Stayed on Treatment for a Year
The results showed that long-term use was low.
Only 24.5% of patients remained on a GLP-1 medication after 12 months. That means fewer than 1 in 4 patients stayed on treatment for a full year.
About 20.6% of patients switched from one GLP-1 medication to another during the year. The remaining 79.4% stayed on their initial medication without switching.
Interestingly, people who switched medications were more likely to stay on treatment overall.
- 36.4% of switchers remained persistent at 12 months
- 21.4% of nonswitchers remained persistent
Switchers also had better adherence. Their average medication coverage was 63%, compared to 52% for nonswitchers. About one-third of switchers reached the 80% adherence goal, compared to 28.6% of nonswitchers.
These findings suggest that switching medications may not mean failure. Instead, it may reflect active management of treatment.
Which Medications Were Most Common?
Semaglutide was the most commonly used starting medication. This included both:
- Wegovy (approved for obesity)
- Ozempic (approved for diabetes but often used off-label for weight loss)
Liraglutide (Saxenda and Victoza) and tirzepatide (Mounjaro) were also used.
Among those who switched, the most common change was from liraglutide to semaglutide. Most people who switched only did so once. A small group went through multiple changes, such as moving from liraglutide to semaglutide and then to tirzepatide.
Injectable semaglutide appeared to play a central role, serving both as a common starting medication and a frequent destination after switching.
Why Might Patients Switch?
The study did not directly measure reasons for switching. However, the authors note that switching may reflect efforts to improve treatment rather than stopping care.
Patients who switched had slightly higher rates of certain health conditions, including:
- Depression
- Sleep apnea
- Gastroesophageal reflux disease (GERD)
- Asthma
- Metabolic dysfunction–associated steatotic liver disease
These conditions may influence medication tolerance or treatment decisions.
The authors suggest that switching should be viewed as part of long-term optimization. As new medications and formulations become available, doctors and patients may adjust therapy to improve results or reduce side effects.
What This Means for Patients and Clinicians
The key takeaway from this study is that long-term persistence with GLP-1 medications remains low in real-world practice.
However, switching medications appears to be common and may help patients stay on treatment longer.
The researchers encourage clinicians to:
- Support continuity of care even when switching medications
- Address barriers such as cost and insurance coverage
- Manage side effects that may limit persistence
The study also highlights the need for future research to better understand how factors such as dosing frequency, medication tolerance, access, and patient preferences influence long-term use.
It is important to note that this study used insurance claims data. Claims data cannot capture medications paid for out of pocket, which may mean persistence rates were slightly underestimated. The results should be interpreted as descriptive rather than proving cause and effect.
Still, this large real-world analysis provides important insight into how GLP-1 medications are used outside of clinical trials.
The Bottom Line
GLP-1 medications are highly effective for weight management, but staying on them long term can be challenging. In this study of nearly 127,000 adults without diabetes, fewer than 1 in 4 remained on therapy after 12 months.
Switching between GLP-1 medications was common and was linked to better persistence and adherence. Rather than seeing switching as a sign of failure, it may represent active and ongoing treatment adjustment.
Understanding these patterns can help improve patient-centered obesity care and support long-term success.
Source
Xie L, Anazco D, Herrera Chancay A, Mathew MS, Francis JM, Almandoz JP, Messiah SE. Glucagon-like peptide-1 receptor agonist switching and treatment persistence in adults without diabetes. JAMA Netw Open. 2026;9(3):e261272. doi:10.1001/jamanetworkopen.2026.1272. Available from: https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2846157#250855078
