Determinants of semaglutide initiation in obesity

In people with obesity but without diabetes, starting semaglutide treatment appears to be influenced by sociodemographic, health care, and clinical factors, according to a retrospective observational cohort study.

Researchers used data from the Merative MarketScan Commercial Claims and Encounters Database. They looked at 97,456 adults (27.3 percent aged 45–54 years, 59.6 percent female, 50.7 percent covered by preferred provider organization plans) with a first diagnosis of obesity and had no diabetes-related claim in the 12 months prior to the diagnosis.

Tenfold cross-classified random forest and multivariable logistic regression models were used to identify factors associated with incident semaglutide prescription within 6 months after obesity diagnoses.

Of the participants, 1,963 (2.0 percent) initiated semaglutide within 6 months of their initial obesity diagnosis. The random forest model yielded an area under the receiver operating characteristic curve of 0.71 (95 percent confidence interval [CI], 0.69–0.74).

Sex, use of antidepressants, and employer industry emerged as the most important exposures via the Shapley Additive Explanations. In the logistic regression model, semaglutide initiation was associated with being female (adjusted odds ratio [aOR], 2.30, 95 percent CI, 2.05–2.58), use of certain medication classes including antidepressants (aOR,1.62, 95 percent CI, 1.46–1.78), and being covered by a point-of-service plan (aOR, 1.78, 95 percent CI, 1.42–2.22).

More studies are needed to identify factors associated with GLP-1 receptor agonist use in those with public payer plans, as well as determine whether concurrent use of common medications impacts effectiveness.