2024 Outlook: Can GLP-1 patients stop taking the drug and keep weight off?

GLP-1 medications were one of the hottest topics in healthcare in 2023, and interest in the weight-loss medications is only expected to increase, which will likely result in different approaches from leading companies.

Eli Lilly’s Zepbound was the most recent injectable anti-obesity medication to burst onto the scene in November after FDA approval, joining an ever-growing lineup of drugs best known for the treatment of weight loss. A recent study in the JAMA Network revealed that tirzepatide, the compound in Zepbound and Mounjaro, helped overweight or obese adults lose on average 20% mean body weight.

Unfortunately, the study solidifies concerns that once patients quit using tirzepatide (or semaglutide, as other studies show), they regain much of their original weight. In the JAMA study, patients who switched to a placebo experienced 14% weight regain, compared to participants who continued taking tirzepatide and lost an additional 5.5% weight.

It’s a warning sign for some companies to reconsider their selling approach as patients, employers and payers manage the high costs of the drugs, said Brooke Boyarsky Pratt, founder and CEO of weight loss clinic knownwell.

“I think you’re going to see more and more of formerly business-to-consumer GLP-1 companies who are now selling into the employer space, claiming to have the silver bullet to GLP-1 spend,” she said. “And what we’ve seen from many of these companies is them saying ‘we may put patients on GLP-1s, but we’ll get them off in 12 months.’

“We’re hearing from employers all over the place that this is what they’re being pitched,” she added. “I think that’s going to be a compelling narrative given how many patients qualify for these drugs and the high cost of them. The difficulty being that there’s no data to support that, and in fact, the data very clearly suggest the opposite.”

She said the concern is patients who follow that guidance will have worse health outcomes, and all parties become disillusioned with the promise of GLP-1s. The solution, she thinks, is to be prepared to leave patients on the drugs for life if they need it, perhaps cycling a patient on to a lower dose or less efficacious medication over time.

Ilant Health founder and CEO Elina Onitskansky told Fierce Healthcare in October that some direct-to-consumer companies have different incentives that can lead to poorer health outcomes.

“I think a lot of what I see in the direct-to-consumer space is hammers in search of nails,” she said. “If you only offer one certain type of treatment, even with the best intentions possible, you're going to lean to suggesting that everyone should get that treatment.

“The direct-to-consumer model has to focus on enrollment,” Onitskansky added. “You basically have to focus on getting paid each month by the same member, and I think a lot of times that results in a focus on faster intake, more enrollment and it’s not necessarily as focused on adherence and outcomes.”

Some companies in the space believe that it’s not advisable for patients to take GLP-1s—at least at the highest dosages—indefinitely.

Telehealth startup Calibrate, which prescribes GLP-1s, faced serious challenges this year, as reported by Business Insider, Fortune and others. The company laid off workers and struggled to meet customer demand due to shortages leading to a high number of refunds before founder Isabelle Kenyon stepped down from her position as CEO.

“While the current clinical paradigm for GLP-1 treatment requires lifelong medication at the highest dose, Calibrate is exploring whether members can be transitioned off of medication while sustaining their results,” shared a Calibrate spokesperson in a statement with Fierce Healthcare. “Accordingly, Calibrate is the first and only program with a proactive plan to get members off of medication.”

That program, Calibrate says, was designed with evidence-based lifestyle interventions and is a more realistic approach for patients who don’t want to stay on GLP-1s forever. The company pointed to a 2018 study in The Obesity Society that shows 10% weight loss is the average attainable weight patients can realistically attain.

Unlike the STEP 1 trial, where participants regained two-thirds of their prior weight loss after ceasing semaglutide utilization but continuing lifestyle intervention, Calibrate conducted its own analysis of 512 of its members to see if it’s possible to keep the weight off through the Calibrate program by tapering the drug’s usage. Its results showed that 93% sustained greater than 10% weight loss six to 12 months after beginning to taper off GLP-1 drugs.

Calibrate advises speaking with a doctor to determine if GLP-1 tapering is appropriate for them but said it could be advisable at a normal BMI or if a patient plateaus for more than three months at a maximum dose of a GLP-1 medication.

Linda Anegawa, M.D., chief of medicine at digital health company Noom, said medication alone is not the answer when some patients experience difficult side effects.

“When people stop the medication without adequate lifestyle support, studies show the weight comes back,” she said in an email to Fierce Healthcare. “This is because drugs alone can’t rewire the brain’s craving pathways or fix insulin resistance. For GLP-1s and other anti-obesity medications to be most effective, it is abundantly clear that they need to be part of a personalized program that reflects the person’s unique metabolic profile, lifestyle, and importantly, personal preferences for ongoing engagement and motivation.

“For some, tapering to a lower dose or to a different medication can provide the desired outcome,” she added. “Others may need longer-term, more continuous treatment to overcome the body’s metabolic adaptation which occurs in response to weight loss.”

Pratt does anticipate the science underpinning these drugs will advance in 2024. She expects an oral pill version of semaglutide could increase demand for anti-obesity medications even further, making it easier and cheaper for patients to take the medicine.

She also believes more data to come out about how GLP-1s can treat other disease states like addiction, the liver and dementia. Additionally, she hopes employers will feel compelled to cover these drugs.

“I think it’s just becoming clear that from an employee retention standpoint, people are recognizing it’s not going to be tenable for very long,” she said.

Assuming the drug becomes more available than in 2023, Express Scripts president Adam Kautzner doesn’t foresee interest in GLP-1s waning anytime soon.

“I see demand staying very strong throughout 2024,” he said. “I think that we will also continue to see utilization rise, which is why we’re putting additional solutions in place to help to able to better manage that the right patients are receiving these medications for the right reasons and that they can benefit the most from them.” 

Senior editor Paige Minemyer contributed to this report.