Radwan Rotana M, Lee Yao An, Kotecha Pareeta, Wright Davene R, Hernandez Inmaculada, Ramon Ronald, Donahoo William T, Chen Yong, Allen John M, Bian Jiang, Guo Jingchuan
Department of Pharmaceutical Outcomes and Policy, University of Florida, Gainesville, Florida, USA.
Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts, USA.
Diabetes Obes Metab. 2025 Jun;27(6):3113-3123. doi: 10.1111/dom.16318. Epub 2025 Mar 4.
To characterize trends in the initiation of newer anti-obesity medications (AOMs) and determine factors associated with their use among obese/overweight populations.
This study utilized electronic health record data from OneFlorida+ (2015-2024). Adults eligible for AOMs were included, defined as having a body mass index (BMI) ≥30 kg/m or a BMI of 27-29.9 kg/m with at least one obesity-related comorbidity. The primary outcome was the initiation of newer AOMs, specifically glucagon-like peptide-1 receptor agonists (GLP-1 RAs) including liraglutide, semaglutide and tirzepatide. Trends across years were examined, and a multivariable logistic regression identified sociodemographic, clinical and healthcare utilization factors associated with AOM initiation.
Of 319,949 adults, 1.8% initiated newer AOMs. Semaglutide accounted for 77.9% of initiations, tirzepatide 19.7% and liraglutide 17.8%. Initiation trends showed liraglutide uptake peaked at 5% in 2018 but declined afterward, while semaglutide and tirzepatide uptake increased exponentially since 2022. Odds of initiation were lower for Black (aOR [95% CI]: 0.87 [0.80-0.94]) and Hispanic (0.84 [0.78-0.91]) groups versus Whites, and for Medicaid (0.69 [0.63-0.76]) and uninsured (0.81 [0.74-0.87]) patients versus privately insured. Higher odds were associated with being female, middle-aged, having more outpatient visits and visiting endocrinologists.
The initiation of newer AOMs among overweight and obese populations remains low, but uptake has increased exponentially since 2022. Our findings reveal significant disparities in obesity care, highlighting the importance of addressing inequities in AOM access to improve obesity outcomes.
描述新型抗肥胖药物（AOMs）起始使用的趋势，并确定肥胖/超重人群中与药物使用相关的因素。
本研究利用了来自OneFlorida+（2015 - 2024年）的电子健康记录数据。纳入符合使用AOMs条件的成年人，定义为体重指数（BMI）≥30 kg/m²或BMI为27 - 29.9 kg/m²且至少有一种肥胖相关合并症。主要结局是新型AOMs的起始使用，具体为胰高血糖素样肽-1受体激动剂（GLP-1 RAs），包括利拉鲁肽、司美格鲁肽和替尔泊肽。研究了各年份的趋势，并通过多变量逻辑回归确定了与AOM起始使用相关的社会人口统计学、临床和医疗保健利用因素。
在319,949名成年人中，1.8%开始使用新型AOMs。司美格鲁肽占起始使用量的77.9%，替尔泊肽占19.7%，利拉鲁肽占17.8%。起始使用趋势显示，利拉鲁肽的使用量在2018年达到5%的峰值后下降，而司美格鲁肽和替尔泊肽的使用量自2022年以来呈指数增长。与白人相比，黑人（调整优势比[aOR][95%置信区间]：0.87[0.80 - 0.94]）和西班牙裔（0.84[0.78 - 0.91]）群体起始使用的几率较低；与私人保险患者相比，医疗补助计划参保者（0.69[0.63 - 0.76]）和未参保者（0.81[0.74 - 0.87]）起始使用的几率较低。女性、中年、门诊就诊次数较多以及就诊于内分泌科医生的人群起始使用几率较高。
超重和肥胖人群中新型AOMs的起始使用率仍然较低，但自2022年以来使用量呈指数增长。我们的研究结果揭示了肥胖治疗中的显著差异，凸显了解决AOM获取方面的不平等以改善肥胖治疗效果的重要性。
