About a Quarter of Those Who Stop Wegovy Start Again

Nearly half of adults who started semaglutide (Wegovy) for obesity management stopped treatment within a year, a Danish cohort study showed.

Among 157,822 first-time semaglutide initiators without diabetes, 49% discontinued treatment by 12 months, defined as a prescription gap of 60 or more days. Discontinuation steadily increased from 13% by 3 months, to 27% by 6 months, and 39% by 9 months.

However, one in four discontinuers restarted therapy within 3 months, Aurélie Mailhac, MSc, of Aarhus University Hospital in Denmark, and co-authors reported in JAMA Network Open.

“These findings may reflect frequent temporary treatment interruptions or self-adjusted dosing below guideline-recommended levels,” they wrote.

The discontinuation of semaglutide for obesity in the first year “is considerable,” and the authors could not identify a subgroup of individuals who were less likely to stop, Mailhac told MedPage Today.

The risk of discontinuation remained 41% or higher across all subgroups stratified by baseline characteristics. On a relative scale adjusted for age and sex, several groups faced elevated risks of stopping, including younger (ages 18-29) versus older (ages 45-59) patients (risk ratio [RR] 1.49, 95% CI 1.47-1.52); men versus women (RR 1.16, 95% CI 1.14-1.17); and those living in a low-income versus high-income municipality (RR 1.11, 95% CI 1.09-1.14).

Risk of discontinuation was also higher among those with:

• Prior psychiatric medication use: RR 1.13, 95% CI 1.12-1.14
• Prior gastrointestinal medication use: RR 1.10, 95% CI 1.09-1.12
• Kidney disease: RR 1.09, 95% CI 1.04-1.15
• Cardiovascular disease: RR 1.08, 95% CI 1.06-1.10
• Prediabetes: RR 1.05, 95% CI 1.03-1.06
• Metabolic syndrome: RR 1.02, 95% CI 1.01-1.03

“This suggests the role of two main factors: financial barriers to long-term therapy, and increased susceptibility to adverse effects in some persons,” noted Mailhac. “Younger individuals and persons with socioeconomic disadvantage may therefore not have had the financial resources to stay on the drug long term.”

These observations are “concerning” because these factors are associated with a more severe obesity burden in Denmark, Mailhac emphasized. “This implies that those who may need semaglutide for obesity management the most currently have the highest likelihood of stopping therapy early.”

Others may have benefited from the drug, fulfilled their individual goals without seeing a need for long-term use, or planned to take semaglutide only briefly from the start, she added. “They may have considered it transitional therapy to acquire healthier weight-reducing habits or to achieve their weight loss goals before stopping.”

Regardless, offering proper support from the beginning is vital to help patients stay on track, Mailhac advised. Key steps include discussing motivations and long-term costs before starting therapy, providing ongoing lifestyle guidance, carefully tailoring dosage titration, and closely monitoring for side effects.

“This could help mitigate side effects, achieve better results, and maintain therapy and weight loss. Individuals may respond very differently to semaglutide for obesity, so individualized follow-up is needed,” she said.

For the nationwide cohort study, researchers examined Danish adults who initiated semaglutide for obesity between December 2022 and November 2024. The median age was 49 years, and 69% were female.

In sensitivity analyses, 12-month discontinuation rates shifted to 58% using a 30-day prescription gap and 45% using a 90-day gap.

After stopping semaglutide, few patients filled prescriptions for alternative GLP-1 drugs indicated for obesity, such as liraglutide (Saxenda; 1.4%) or tirzepatide (Zepbound; 0.7%).

Study limitations included a lack of post-initiation weight-loss data, missing individual-level income, and insurance coverage details. The findings may not apply fully to other countries, Mailhac noted.

“Studies from the U.S. have also shown high discontinuation results among individuals starting novel obesity management medications … with numbers up to 60% over the first year, at least as high as ours,” she explained. “However, differences in drug price, coverage by insurance companies, reimbursement policies, as well as availability of compounded products affect both countries differently and could affect overall discontinuation.”