GLP-1 persistence has nearly doubled since 2021 — what the research shows

• 1-year persistence among initiators of high-cost anti-obesity medications rose from 33.2% in 2021 to 60.9% in the first half of 2024 (JMCP 2026, PMID 41760566).
• Semaglutide persistence improved steadily: 33.2% (2021), 34.1% (2022), 39.8% (2023), 58.6% (1H 2024).
• Tirzepatide showed higher persistence from its first full year of data: 64.0% (2023) and 64.8% (1H 2024).
• "Persistence" means staying on the medication for 12 months — not achieving a specific weight-loss target.

The study — "Trends in 1-year persistence and adherence among initiators of high-cost anti-obesity medications" — was published in JMCP in 2026 (volume 32, issue 3, page 281, DOI 10.18553/jmcp.2026.32.3.281, PMID 41760566). It used real-world insurance claims data to track patients who started high-cost anti-obesity medications (GLP-1 receptor agonists) and measured whether they were still filling prescriptions 12 months later.

This is real-world claims data — not a randomized clinical trial. Participants are not followed under controlled conditions; they are people who started a medication in ordinary clinical care. That makes the data highly relevant to real-world practice, but it means the study cannot establish why persistence changed, or what outcomes persistent patients achieved.

What "persistence" means here: a patient counted as persistent at 12 months is still filling their prescription at that point. The measure says nothing about dose, whether they adhered within each week, whether they achieved their weight-loss goals, or why they stayed on. Persistence is a necessary but not sufficient condition for the drugs to produce their full benefit.

Overall 1-year persistence across all high-cost anti-obesity medications rose from 33.2% in 2021 to 60.9% in the first half of 2024.

For semaglutide specifically, the year-by-year progression from 2021 through 1H 2024: 33.2%, 34.1%, 39.8%, 58.6%. That is a steady, substantial upward trend over four years.

Tirzepatide's numbers, available from 2023 (its first full commercial year), were already above semaglutide from the start: 64.0% in 2023 and 64.8% in the first half of 2024.

By the most recent period in this dataset, both drugs have converged toward similar persistence ranges — with tirzepatide still higher, but semaglutide no longer trailing by the wide margin seen in 2021.

Tirzepatide’s higher persistence numbers could reflect several things. Tirzepatide, a dual GLP-1 and GIP receptor agonist, is associated with greater average weight loss than semaglutide in head-to-head trial data. Greater visible results may reinforce continuation.

But there are confounding factors: tirzepatide was newer in this period and may have been prescribed more selectively by physicians with greater obesity medicine engagement. Patients who received it may have had different insurance dynamics. The study observes that tirzepatide users persisted at higher rates — it does not establish that tirzepatide caused higher persistence.

The rise in semaglutide persistence from 33.2% to 58.6% over four years coincides with several developments: the 2021 approval of Wegovy for obesity, growing recognition of GLP-1s as chronic rather than short-term medications, broader prescriber training in obesity medicine, more consistent use of gradual dose escalation to manage GI side effects, and potentially a shift in which patients were being prescribed these drugs.

This is correlation in claims data. No single factor can be isolated.

Persistence is a useful signal, but several things matter more clinically:

• What weight outcomes persistent patients actually achieved
• Why patients who stopped left — side effects, cost, access, personal decision, or clinical guidance
• Whether improved persistence translates to better cardiometabolic outcomes — plausible, but not measured by this study
• Whether the first half of 2024 trend continued — this dataset covers through 1H 2024; what happened in late 2024 and 2025, particularly given the compounded semaglutide disruptions, remains to be captured

• Given that more patients are staying on GLP-1s longer, should we map out a long-term plan now rather than treating this as a short-term intervention?
• What is the difference between persistence (staying on the medication) and adherence (taking it as directed), and what does each look like in my case?
• If I've had trouble staying on a GLP-1 before, what clinical support is available to help me sustain treatment?
• How does your approach to dosing and side-effect management reflect the practices associated with better persistence in real-world data?

• Monthly prescription fills — a single gap can become a pattern; know your refill timeline
• Weight, cardiometabolic markers, and side effects — log these so your prescriber can adjust dosing if needed
• Insurance and cost status — a coverage change is one of the most common drivers of unexpected stops; knowing your options in advance matters

The JMCP data offers genuine signal that GLP-1 use has changed. People are staying on these medications at meaningfully higher rates than they were four years ago. For a drug class whose benefits — particularly cardiovascular protection — appear to require sustained use, that shift matters.

But a doubling of persistence rates does not mean the adherence problem is solved. Even at 60.9%, roughly 4 in 10 people initiating high-cost anti-obesity medications as of 1H 2024 still stopped within a year. The reasons they stop — cost, side effects, access barriers, ambivalence about long-term medication use — are real and haven't disappeared.

If you are starting or staying on a GLP-1 medication, the most important factor in whether you stay with it isn't the national trend — it is your individual clinical relationship, your side-effect management plan, your access to refills, and whether you and your prescriber have mapped out what long-term treatment looks like together.

The numbers suggest more people are finding their way to that. But the plan is still yours to build.

Medical disclaimer: This content is for educational purposes only and is not medical advice. Always consult a licensed healthcare professional before starting, stopping, or changing any treatment.

Sources

• Trends in 1-year persistence and adherence among initiators of high-cost anti-obesity medications. JMCP 2026;32(3):281. DOI: doi.org PMID: 41760566
• PubMed: pubmed.ncbi.nlm.nih.gov
• PMC full text: pmc.ncbi.nlm.nih.gov
• Medscape coverage: medscape.com