Adolescent GLP-1 prescriptions increased 6-fold from 2020 to 2023

The amount of adolescents and young adults receiving GLP-1 receptor agonists including semaglutide (Ozempic) and tirzepatide increased approximately 6-fold from 2020 to 2023, according to findings from a new research letter.¹

A team of US-based investigators reported new findings showing the popularized drug class—indicated for the treatment of diabetic, cardiometabolic and obesity management-related outcomes—was dispensed to nearly 31,000 US adolescents in 2023 alone. The findings suggest a strong need for pediatricians to apply uniform and evidenced treatment guidance during the major trend in clinical weight and cardiometabolic disease management.

Led by Joyce M. Lee, MD, MPH, of the Susan B. Meister Child Health Evaluation and Research Center at University of Michigan Medical School, the research team sought to assess the dispensing of GLP-1s to US adolescents and young adults aged 12 - 25 years old over the 4-year span of 2020 - 2023. As they noted, an absence of long-term health data exists for this emerging, highly efficacious and often costly drug class.

“GLP-1s were approved for type 2 diabetes in 2005 and for weight management in 2014,” the team noted. “Interest in these drugs has surged, spurred partly by the approval of semaglutide for weight management in 2021.”

Semaglutide (Wegovy) was approved for the treatment of obesity in pediatric patients ≥12 years old in January 2023, on the basis of late-stage clinical trial data showing a mean body mass index (BMI) change of 16.1% among treated patients over 68 weeks.²

The team collected dispensing data for the drug class in the observed time period through the IQVIA Longitudinal Prescription Database that which reports prescriptions from >93% of US retail pharmacies.¹ The GLP-1s included in the assessment were dulaglutide; exenatide; liraglutide; semaglutide; and tirzepatide. The 3 agents were previously approved for type 2 diabetes treatment in adolescent patients; liraglutide is indicated for adolescent and adult weight management; tirzepatide is only indicated for for adult weight management; semaglutide is indicated for both adult and adolescent type 2 diabetes and weight management.

Because the database additionally included patient-level identifiers, investigators were able to calculate the monthly number of adolescents and young adults with dispensing of any GLP-1s and specific agents overall based on patient sex.

The team observed that the count of adolescents and young adults dispensed a GLP-1 increased from 8722 in 2020 to 60,567 in 2023—a 594.4% increase. “For comparison, the number with dispensing of drugs other than GLP-1RAs decreased…3.1%,” investigators wrote.

Based on patient sex, females adolescents reported a greater increase in GLP-1 dispenses during that time (587.5% vs 503.8% in men); a similar trend was observed in female young adults versus male young adults (659.4% vs 481.1%). Dulaglutide, exenatide and liraglutide dispenses were greatest among adolescents during the period and increased steadily annually.

Investigators additionally observed a “sharp” increase in injectable semaglutide dispenses for weight management indications in 2023.

“Among young adults, the number who were dispensed dulaglutide, exenatide, or liraglutide was greatest in 2020 and 2021, but was surpassed by the number who were dispensed injectable semaglutide for type 2 diabetes in 2022 and 2023,” Lee and colleagues wrote. “The number who were dispensed tirzepatide increased sharply in 2022 and the number who were dispensed injectable semaglutide for weight management increased sharply in 2023.”

Approximately 60% of all 30,947 dispenses of GLP-1s to US adolescents in 2023 were provided to female patients; nearly half (45.7%) were dispensed to adolescents in the South. Payer type among adolescents was primarily Medicaid (48.0%); one-third (32.7%) of all prescribers were endocrinologists, and another one-fourth (26.4%) were nurse practitioners.

In discussing the findings, Lee and colleagues stressed the importance of disseminating sex-specific safety outcome information to young patients receiving GLP-1s. Indeed, Kevin Peterson, MD, a professor in the department of family medicine and community health at the University of Minnesota and vice president of the American Diabetes Association (ADA), recently told sister publication HCPLive that GLP-1s carry female-specific risks, regardless of their robust benefit-risk profiles.³

“I think one of the side effects that we see with tirzepatide that's probably not all that well known is that it decreases the effectiveness of birth control pills,” Peterson said. “We see if we have young women that are taking this, we have to be careful, because the likelihood of pregnancy will increase if they are using an oral birth control agent.”

Though the research was limited by the lack of data on prescription indications for the dispensed GLP-1s, they concluded their findings show a substantial jump in young Americans receiving the drug class since only 2020.¹

“Evaluation of the long-term safety, efficacy, and cost-effectiveness of GLP-1s in adolescents and young adults is needed,” investigators wrote. “Data on dispensing in adults, which were not available for analysis, would help contextualize results in younger individuals.”

References

1. ^{Lee JM, Sharifi M, Oshman L, Griauzde DH, Chua K. Dispensing of Glucagon-Like Peptide-1 Receptor Agonists to Adolescents and Young Adults, 2020-2023. JAMA. Published online May 22, 2024. doi:10.1001/jama.2024.7112}
2. ^{Krewson C. FDA approves semaglutide for obesity in adolescents. Contemporary Pediatrics. Published January 3, 2023. https://www.contemporarypediatrics.com/view/fda-approves-semaglutide-for-obesity-in-adolescents}
3. ^{Kunzmann K. GLP-1 Agonist Safety Risks and Obesity Stigma with Kevin Peterson, MD, MPH. HCPLive. Published May 19, 2024. https://www.hcplive.com/view/glp-1-agonist-safety-risks-obesity-stigma-kevin-peterson-md-mph}