High-dose semaglutide starts raise early discontinuation risk 25% in US claims study

The wire

1. 01MarketScan data from 2018-2021 showed off-label high-dose initiation cut 1-year persistence (p=0.01) and raised early discontinuation risk (HR 1.25, 95% CI 1.17-1.34), independent of age, obesity status, comorbidity and cost.
2. 02Prescribers and telehealth operators have a modifiable lever: titration practice itself, not just cost or side-effect tolerance, predicts who stays on therapy at a year.
3. 03Odds of high-dose starts were higher in the West and South, among endocrinologists, and for male, younger patients; the retrospective claims design cannot establish causation.

From the source

Real-World Semaglutide Initiation Behaviours in the United States: Impact on Early Treatment Discontinuation and on 1-Year Persistence

Diabetes, obesity & metabolism · 2026 Oct 19 · Belalcazar LM, Gao D, Modi S et al.