MON-705 Initiation of Semaglutide: Understanding National Prescription Behaviors in Real-World Practice

Abstract Disclosure: S. Modi: None. D. Gao: None. Y. Kuo: None. L. Belalcazar: None. Introduction: Injectable semaglutide was originally prescribed for type 2 diabetes, but its rise in popularity for management of overweight/obesity (OW/obesity) has resulted in a desire to maximize weight loss response using higher doses. Adverse gastrointestinal effects commonly lead to treatment discontinuation. Prescribers are advised to start with the lowest dose of 0.25 mg weekly and slowly increase. This study investigates dose initiation practices in the United States with insights on dose prescriber behavior by year since approval, specialty, practice location, and patient characteristics. Methods: Using Merative MarketScan, one of the largest national databases with individual-level information and prescription data, we identified the first dose of prescribed weekly injectable semaglutide for adults age ≥45 years occurring on/after 01/2018. Patients were included if they were in the database for ≥ 1 year prior to initial prescription and if they had a diagnosis of diabetes (DM) or OW/obesity (n=48,658). National Drug Codes were used to identify semaglutide doses. Initiating doses were dichotomized as low (<=0.5 mg/week) or high (>0.5 mg/week). To understand prescription behavior, we examined the odds of semaglutide high-dose initial prescription (SHDi) using multivariable logistic regression including prescription year and region, prescriber type, patient age, gender, and OW/obesity diagnosis as independent variables. Results: 92.5% of patients started on semaglutide had a DM diagnosis. Overall, when compared to 2018, the odds of SHDi decreased 16% in 2019, 40% in 2020, and 37% in 2021. The odds of SHDi were higher for male patients (OR 1.14; 95% CI: 1.08-1.20) and in the Midwest (OR 1.20; 95% CI: 1.09-1.33), South (OR 1.52; 95% CI: 1.40-1.65), and West (OR 1.62; 95% CI: 1.44-1.82). Younger age (OR for age 45-54 years: 1.15; 95% CI: 1.04-1.28, and OR for age 55-64 years: 1.10; 95% CI: 1.01-1.12) and an OW/obesity diagnosis (OR 1.19; 95% CI: 1.04-1.36) were associated with higher odds of SHDi. It appears that endocrinologists (OR 1.08; 95% CI: 1.01-1.16) were more likely than primary care providers to initiate high-dose semaglutide. No significant difference on odds of SHDi was found by semaglutide brand. Conclusion: Our results suggest that SHDi has decreased over time, but that high-dose initiation is more prevalent among prescribers practicing in the West and South United States and when the involved patients are younger, OW/obese, and men. Presentation: Monday, July 14, 2025