Summary: GLP-1s could be valuable in treating additional populations, although their high costs remain a barrier.
Two recent articles point to the potential expanded use of of GLP-1 medications, currently used to treat diabetes, obesity, sleep apnea, and some types of heart and liver disease.
The first, in JAMA Pediatrics, reviews 18 randomized trials with a total of 1,402 participants ages 6-17, and finds that this category of medication is effective at lowering weight and improving HbA1C in this diffficult-to-treat population. Most of these studies evaluated older GLP-1 medications that were largely used for diabetes; only one study was of semaglutide and none were of tirzepatide. Gastrointestinal side effects are far more common in those on GLP-1 medications, but increased discontinuation due to adverse effects did not reach statistical significance.There was no signal of higher risk of suicides or suicide attempts.
The second, in JAMA Psychiatry, reviews the literature on GLP-1 medications to counteract the weight gain associated with major tranquilizers, the category of drugs used to treat major psychiatric disorders, including schizophrenia and bipolar disease. These drugs are effective at decreasing psychiatric symptoms, but are associated with significant weight gain and bad metabolic outcomes, including prediabetes and diabetes. Some people who would benefit from these medications will not take them due to the likely weight gain.
The authors review randomized trials of both liraglutide (Saxenda and Victoza) and semaglutide (Wegovy and Ozempic), and find that the GLP-1s are well tolerated and effective at limiting weight gain and adverse metabolic outcomes is those treaeted with major tranquilizers.
Semaglutide and liraglutide are both approved for use in those over 12 years of age, although many employer-sponsored plans restrict coverage to adults (or don’t cover this class of medicines altogether for obesity). Tirzepatide is only approved for use in those over age 18.
Implications for employers:
GLP-1s are proving effective in more populations, including adolescents and patients on antipsychotics.
High drug costs remain a major driver of medical inflation.
Price relief may come from new competitors and CMS negotiation (2027) for semaglutide.
Older GLP-1s may offer a lower-cost option for children, though with less weight loss than newer drugs.
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