Use and Potential Misuse of Glucagon-Like Peptide-1 Receptor Agonists in France: A Nationwide Cohort Study

OBJECTIVES: Glucagon-like peptide-1 receptor agonists (GLP-1 RAs), introduced in France in 2008 for type 2 diabetes mellitus (T2DM), have been indicated in the treatment of obesity with comorbidities since 2021. Their sharply increasing use over the last years led to supply shortages. Additionally, misuse is suspected in participants searching for weight loss. Consequently, this study aimed to describe the use of GLP-1 RAs in France and evaluate its potential misuse. METHODS: Incident users of GLP-1 RAs between January 01, 2017 and June 30, 2023 were identified in the French national health database based on the following possible indications: T2DM, obesity, and absence of T2DM or obesity. Monthly trends in GLP-1 RA use by indications were analyzed. Profiles of incident users from January 01, 2017 to June 30, 2023 were described. RESULTS: As incident GLP-1 RA users increased (5117 in January 2017 to 15 193 in June 2023), the proportion of GLP-1 RA users without T2DM or obesity rose from approximately 2% in 2020 to >5% in May 2022. These latter users, predominantly women (68.7%) who are younger than T2DM users (48.9 vs 62.0 years), included 4683 individuals (2.2% of all users) without comorbidities associated with overweight. They used predominantly OZEMPIC® (semaglutide). The use of GLP-1 RAs by these users was marked by a high proportion of single dispensing. Their consumption was equivalent to the annual treatment for approximately 1700 patients with T2DM or obesity. CONCLUSIONS: GLP-1 RA use has risen sharply, particularly among individuals without T2DM or obesity. Potential misuse was identified in 2.2% of users. This misuse still warrants further monitoring because the risks are unclear.