Patterns of Use for GLP-1 Receptor Agonists in a Weight Management Cohort: A Military Health System Database Analysis of Active Duty Service Members From 2021 to 2025

Introduction Glucagon-like peptide-1 receptor agonists (GLP-1RAs) are increasingly prescribed for weight management, but real-world data on long-term persistence are crucial for understanding their effectiveness. This study aimed to compare persistence, adherence, and predictors of discontinuation among new users of different GLP-1RAs in the Military Health System (MHS). Materials and Methods This is a retrospective cohort study of 10,649 active duty service members (ADSMs) who initiated therapy with liraglutide (Saxenda), semaglutide (Wegovy), or tirzepatide (Zepbound) between January 1, 2021, and December 31, 2025. Persistence was defined as the time to the first gap in therapy exceeding 90 days. We used Kaplan-Meier survival analysis to estimate persistence rates and a multivariable Cox proportional hazards model to identify predictors of discontinuation. Results Significant differences in treatment outcomes were observed across all agents. Patients initiating Zepbound demonstrated the highest mean yearly adherence (proportion of days covered [PDC]: 78.2%), followed by Wegovy (71.6%), and Saxenda (48.7%). One-year persistence was highest for Zepbound (81.9%) and Wegovy (70.7%), and significantly lower for Saxenda (34.2%) (log-rank P < .001). In the adjusted Cox model, compared to Wegovy, the hazard of discontinuation was 33% lower for Zepbound (hazard ratio [HR]: 0.67, 95% confidence interval [CI]: 0.61-0.74) and 26% higher for Saxenda (HR: 1.26, 95% CI: 1.01-1.16). Male service members also had a significantly higher hazard of discontinuation compared to females (HR: 1.12, 95% CI: 1.02-1.22). Conclusions In this large cohort of ADSMs, Zepbound and Wegovy were associated with substantially higher persistence and adherence compared to Saxenda. These findings have important implications for clinical decision-making and formulary management to optimize long-term outcomes for weight management.