Oral Wegovy Broadens Care Continuum Across First-Time GLP-Starters, High Cardiometabolic Burden GLP-Switchers, and Medicare-Age Patients
Abstract
Oral Wegovy (semaglutide weight-loss pill) initiation now spans two clinically distinct real-world entry states: “GLP-starters” without recent GLP-1 receptor agonist (GLP-1RA) prescriptions and “GLP-switchers” with a recent record for a different injectable or oral incretin therapy. Using a large federated U.S. electronic health record network, we studied the five-year history prior to Wegovy pill initiation. Of 891,711 patients with at least one GLP-1RA prescription, 11,215 initiated the Wegovy pill, of whom 6,283 (56.0%) were GLP-starters and 4,932 (44.0%) were GLP-switchers. GLP-starters and -switchers were similar in age (mean 52.4 vs 52.1 years; P=0.21) and sex (75.4% vs 74.4% female; P=0.22). In contrast, GLP-switchers had significantly greater pre-index cardiometabolic and neuropsychiatric burden than GLP-starters (all q<0.001, Benjamini-Hochberg FDR), including type 2 diabetes (Relative Risk [RR] 1.95), obstructive sleep apnea (RR 1.78), heart failure (RR 1.73), atrial fibrillation (RR 1.55), coronary artery disease (RR 1.38), depression (RR 1.32), and migraine (RR 1.25). Of 3,216 disease phenotypes screened, large language model (LLM)-curated clinical notes showed 819 phenotypes significantly higher at baseline in GLP-switchers and none in GLP-starters (all q<0.001), including morbid obesity (RR 1.61), excessive daytime sleepiness (RR 1.56), and fatty liver disease (RR 1.47), with concordantly higher Elixhauser comorbidity index ≥5 (RR 1.47). Among GLP-switchers to…
How strong is the evidence?
Evidence Hub reads this as a cohort study, done in people. Its evidence level is 3 of 5 (Moderate · trial / cohort / secondary analysis). Trials without a large randomized design, cohorts and secondary analyses give moderate evidence. Reported size: 891,711 participants or records.
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