Abstract:
Obesity is a complex worldwide concern, impacting mortality, morbidity, and quality of life. Glucagon-like peptide 1 (GLP-1) receptor agonist medications are rapidly changing the landscape of obesity pharmacotherapy management. Yet challenges persist in understanding the current existing literature related to similarities and differences between efficacy and real-world effectiveness outcomes and adherence. This scoping review aims to provide an overview of the current efficacy and effectiveness of GLP- 1s to identify gaps in knowledge for future research inquiry.
A scoping literature search using databases Medline, PsycINFO and CINAHL was completed following Arksey and O’Malley's five stage methodological framework. Retrieved articles were screened using a pre-specified inclusion and exclusion criteria. Data were extracted and analysed in Microsoft Excel to identify emerging patterns and themes.
Following screening 19 studies were included. Five themes were identified: efficacy of GLP-1s in weight loss, effectiveness of weight loss GLP-1s in real-world setting, participant demographics, adherence and persistence, industry sponsorship and conflicts of interest. Clinical trials demonstrate clinically significant weight loss efficacy with GLP-1 use, which is reflected in real-world clinical practice data. However, real- world adherence rates vary considerably, with dropout ranging from 24% to 70.1% compared to 15% to 30% in research trials. Ethnicity representation in research remains limited, with potential differential responses to GLP-1 treatment.
While clinical trials establish the efficacy of GLP-1 treatments, real-world challenges highlight the need for a more comprehensive understanding of patient perspectives, adherence behaviours and possible response differences between ethnicities. The dominance of pharmaceutical sponsorship highlights the importance of diversifying research and prioritising patient-centred approaches. Integrating qualitative methodological approaches can offer deeper insights into patient expectations and experiences, informing the development of tailored clinical care pathways to optimise treatment outcomes of GLP-1 medication and address disparities in obesity management.
Audience take away notes:
- Gain a comprehensive overview of the efficacy and real-world effectiveness of GLP-1 receptor agonists, leading to better- informed decisions in clinical practice.
- Challenges: Recognise the variability in adherence rates between clinical trials and real-world settings, prompting the development of strategies to improve patient compliance.
- Understand the importance of ethnic diversity in research and its impact on treatment outcomes, encouraging inclusive study designs.
- Research sponsorship: be aware of the influence of pharmaceutical sponsorship on study outcomes and the need for independent research.
- Use the insights on efficacy and adherence to tailor treatment plans that enhance patient outcomes and minimise dropout rates.
- Improve patient engagement: include and develop patient-centered approaches and educational materials to address adherence issues and support patients throughout their treatment journey.
- Diverse representation: implement strategies to ensure diverse patient populations are considered in treatment plans.
- Expand on the identified gaps, such as the need for more diverse populations and independent studies, to conduct further research to understand and address adherence.
- Teaching: Use the findings to teach students about the importance of considering both clinical trial data and real-world evidence in pharmacotherapy, as well as the ethical considerations of pharmaceutical sponsorship.
- Clinical care pathway design: Inform the design of patient-centered clinical care pathways, treatment interventions, and adherence support tools that are informed by real-world data and patient perspectives. Highlights the importance of considering co-design and understanding patient experiences for more effective clinical pathways to improve treatment adherence.
