Cohort study finds frequent discontinuation of semaglutide for obesity

A retrospective cohort study of 34,309 adults without diabetes initiating Wegovy in Israel found that 36.5% had discontinued by 180 days and 67.6% by one year. Discontinuation was associated with sociodemographic factors and early treatment characteristics; the study also examined early tirzepatide uptake after coverage began.

Two-thirds had discontinued semaglutide by one year.
Discontinuation was associated with socioeconomic and demographic factors.
Lower early weight loss was associated with higher discontinuation.
Tirzepatide uptake was 8.6% over median 3.1 months.

Researchers analyzed Clalit Health Services records for adults without diabetes who started semaglutide (Wegovy) for obesity between January and May 2025. Discontinuation was defined as a medication-coverage gap exceeding 60 days. The retrospective cohort included 34,309 people (67.0% women; mean age 44.6 years); Cox models assessed factors associated with discontinuation, including in a Day-90 landmark analysis.

Cumulative discontinuation was 36.5% at 180 days and 67.6% at 365 days. Higher discontinuation hazards were associated with Arab population sector (HR 1.65, 95% CI 1.59–1.72), low socioeconomic status and current smoking (both HR 1.13). Among 28,218 people in the Day-90 analysis, remaining on 0.25 mg rather than 1.0 mg was associated with subsequent discontinuation (HR 1.88); this association was substantially attenuated after adjustment for early refill adherence. Each percentage-point smaller BMI reduction was associated with a 3% higher discontinuation hazard.

After tirzepatide coverage was introduced in December 2025, 8.6% of 33,936 eligible participants initiated it over a median 3.1 months. The findings describe associations in one health-service population, not causal effects, and may not generalize beyond its setting. Dose and early weight-loss response may help identify people at higher risk of stopping, but the study does not establish interventions to improve persistence.

In practice

For adults without diabetes starting semaglutide for obesity, this cohort found substantial treatment discontinuation—67.6% by one year—and associations with socioeconomic characteristics, early dose, refill adherence and BMI response. These factors may help characterize persistence risk, but the retrospective observational results do not show that changing dose or intervening on these factors will prevent discontinuation. Findings come from one health-service population in Israel and should not be assumed to generalize to other settings.

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Source

Diabetes, Obesity and Metabolism: Early Treatment Trajectory and Long‐Term Persistence to Semaglutide for Obesity: A Population‐Based Cohort Study ↗

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