Expert Insight: Long-Term GLP-1 Use Often Necessary to Maintain Weight Loss, Health Benefits

In an interview with Pharmacy Times®, Donna Ryan, MD, professor emerita from the Pennington Biomedical Research Center in Baton Rouge, Louisiana, discusses the long-term treatment protocol associated with glucagon-like peptide-1 (GLP-1) receptor agonists and how research is underway to determine how patients can feasibly stop treatment. Often, patients who stop treatment with GLP-1s can experience weight rebound and a loss of health benefits, Ryan explains, noting that if patients stop treatment and experience complications, they should resume their treatment immediately.

Closed captions for this video were auto-generated with artificial intelligence.

Pharmacy Times: After patients finish their treatment with GLP-1s, should they be sustaining dietary changes and nutritional changes for the long-term future? Is stopping treatment feasible?

Ryan: You know, we don't really know how to stop these medicines. That's the truth. What I can tell you is that if you continue the medicine, your weight loss will be maintained. The improvement in your blood glucose and in your A1c will be maintained. Whatever benefits you're getting in cardiovascular risk reduction will be maintained. Your improvements in sleep apnea will be maintained. So, staying on the medication will sustain your weight loss and sustain your health benefits. But we do not know how to stop these drugs and sustain those benefits. Right now, our current recommendation is that patients stay on them. Sometimes patients will stop because they were taking them to achieve a certain amount of weight loss. Once people lose weight, they feel great, and they think, “Oh, I got this covered now; I'm not going back to my old pattern of lifestyle.” But it's very difficult to maintain lost weight. It's virtually impossible. There are studies underway where we're looking at different strategies to try to reduce the dose, spread out the dose, maybe even stop the dose. But those studies haven't been completed, so I can't really give any advice about stopping them. It's something that we really need to be aware of. If you do stop, if you start to gain weight, for heaven's sake, don't wait till you regain all your weight; go back to your doctor and get started again.

There's one thing that I'd like to discuss, and that is how difficult it is for people to afford these drugs. It's very difficult. Sometimes, patients will go to what's called “compounding medications” that they get online or in other places. I cannot recommend this. I do not know for sure what is in those compounded medications. The compounding pharmacies are using drug lots that come from China that are not scrutinized in the way that they are when the FDA has given their approval for a product; that product is specially monitored. When we have the brand name products that are produced and sold here in the United States, we know what those are. I don't know what these compounded molecules are, and I can't endorse them, so I advise patients to stay away from that. The field is getting better, and we're going to solve this cost problem.

Pharmacy Times: What role can they play in advising patients regarding compounded versions of these GLP-1s and the proper dosing and administration of these medications as well?

Ryan: Well, you know, the medications that are marketed come with a pin. They're very simple. You don't have to use a needle to draw anything up. The pin, it's minuscule. You just put the pen against your skin and hold it there, press the button, and magically, the dose enters your body. Sometimes people do not even feel it, and you hold it there for at least 15 seconds, and then you take your pen away from the body and dispose of it. The drugs that are out on the market, both Wegovy and Zepbound, come with an easy-to-use and administer formulation. The one thing people need to be aware of is don't get the wrong dose to start with. You want to start with .25 milligrams for Wegovy, and you want to start with 2.5 milligrams for tirzepatide. Sometimes there will be an error made, and the patient's given the wrong dose. By all means, check your dose. But that's pretty much it. They really are totally easy to use. The compounding drugs, I do not advise. Now, those have to be drawn up in a syringe. If you are getting some crazy product online that's in a pen, it may not even be the right molecule. So be careful about that. Don't do that.

Pharmacy Times: Is there anything else that you wanted to add?

Ryan: I’d like to add one thing. I think everybody is interested in losing weight and looking their best and feeling their best, and there's nothing wrong with that. That's a good thing. But there are health benefits of behaviors that patients need to be aware of. There are health benefits of a healthy diet. There are health benefits of being physically active. We need to incorporate those in our efforts to lose weight, to feel better, to feel better about ourselves, and to function better. So that's my number 1 thing. These new GLP-1 medications are truly a medical advance because of the effect on our health. I frankly don't care what your body size is. I don't care if you wear a size 20 or a size 2. What I care about is your health. The thing about these medications is that they improve health for many of the chronic diseases that we're treating. For diabetes, for pre-diabetes, for hypertension, for cardiovascular diseases, for people who have problems with their lipids, for sleep apnea, and for knee osteoarthritis. These medications are powerful, wonderful, health-promoting medications, and we need to treat them seriously. These are not just a medication to take because you want to get in a special dress for some event.