Real-world US study: one-third of semaglutide patients continue monotherapy through first year of treatment | Research

The takeaway

Among 15,588 US patients initiating once-weekly semaglutide, monotherapy was the most common first regimen, with 36.5% maintaining one treatment line and 42-46% of those reaching second/third lines continuing semaglutide-containing regimens.

Monotherapy dominates
Among 15,588 US patients starting semaglutide, monotherapy was the most common initial regimen with 36.5% maintaining it throughout the first year

What the researchers found

15,588 patients. 1st LOT: semaglutide monotherapy most common. 36.5% maintained 1st LOT throughout follow-up. 2nd LOT: 42.2% included semaglutide. 3rd LOT: 45.8% included semaglutide. Persistence: 52.1% (2nd LOT) and 72.0% (3rd LOT) continued to end.

Why it matters

Understanding how semaglutide is actually used in clinical practice—not just how it works in trials—helps prescribers make informed treatment decisions and predict patient trajectories.

How the study worked

Retrospective claims-based study of US patients with T2DM initiating OW semaglutide (Jan 2018-Dec 2019). At least 1 year follow-up. Lines of therapy (LOT) and regimen analysis.

What this study cannot tell us

Claims data cannot capture clinical reasoning. Early post-launch period (2018-2019) may not reflect current prescribing. Cannot assess glycemic outcomes. US-specific insurance landscape.

How to read the evidence

Large retrospective claims analysis. Good for prescribing patterns but cannot assess clinical outcomes.

When this study was published

Published in 2025; data 2018-2019.

The bigger picture

The dominance of monotherapy and high persistence suggest semaglutide is often sufficient as a standalone diabetes treatment in the real world, supporting its use as a first-line injectable after oral agents.

Questions still open

Has prescribing changed since broader indications were approved?
What drives regimen changes—inadequate response or side effects?
Would current prescribing show more semaglutide + SGLT2i combinations?

Common questions

How is semaglutide typically prescribed in real life?

This study of 15,588 US patients found that most start semaglutide as their only diabetes medication (monotherapy). About one-third stay on this single regimen. When treatment changes are needed, about 42-46% of patients keep semaglutide as part of their new regimen, showing strong drug persistence.

Do most people stay on semaglutide?

Yes. 36.5% stayed on their initial semaglutide regimen throughout the study period. Even among those who changed treatments, nearly half continued semaglutide as part of a combination. The high persistence rate suggests most patients find the drug effective and tolerable.

Read the original research

Real-World Treatment Patterns Among US Patients With Type 2 Diabetes Mellitus Initiating Treatment With Once Weekly Semaglutide for Diabetes.

Clinical therapeutics, 47(4), 277-283

View on PubMed ↗Publisher’s paper ↗

Citation

Swift, Caroline; Frazer, Monica; Sargent, Andrew; Leszko, Michael; Buysman, Erin; Gronroos, Noelle N; Alvarez, Sara; Dunn, Tyler J; Noone, Josh. (2025). Real-World Treatment Patterns Among US Patients With Type 2 Diabetes Mellitus Initiating Treatment With Once Weekly Semaglutide for Diabetes.. Clinical therapeutics, 47(4), 277-283. https://doi.org/10.1016/j.clinthera.2024.12.014