Nearly Half of Danish Semaglutide Users Stop in the First Year

A nationwide Danish cohort study published in JAMA Network Open tracked 157,822 adults without diabetes who began semaglutide, sold as Wegovy, for obesity management between December 2022 and November 2024. Nearly half stopped within a year: 49% had a prescription gap of at least 60 days. Discontinuation rose steadily from 13% at 3 months to 27% at 6 months and 39% at 9 months. Notably, one in four people who stopped restarted treatment within 3 months.

The researchers could not identify any group that was clearly less likely to stop. The risk of discontinuation remained 41% or higher across all subgroups examined. Compared with older patients aged 45-59, adults aged 18-29 had a 49% higher relative risk of stopping. Men had a 16% higher risk than women, and people living in low-income municipalities had an 11% higher risk than those in high-income areas.

Higher discontinuation risk was also seen in people with prior psychiatric medication use, prior gastrointestinal medication use, kidney disease, cardiovascular disease, prediabetes and metabolic syndrome. The authors interpret the findings as pointing to two main barriers: the cost of long-term therapy and greater susceptibility to side effects in some patients. After stopping semaglutide, few people switched to another GLP-1 drug approved for obesity: only 1.4% filled a prescription for liraglutide and 0.7% for tirzepatide.

What the Discontinuation Patterns Show About Cost, Side Effects and GLP-1 Switching

Cost and Side Effects Appear to Drive Much of the Problem

The study does not directly measure why people stopped, but the pattern points to two mechanisms. The higher discontinuation risk in low-income municipalities and among younger adults suggests affordability is a real barrier to long-term treatment. At the same time, patients with prior gastrointestinal or psychiatric medication use may be more likely to experience difficult side effects or tolerate the drug less easily. These are not separate categories; a patient can face both financial pressure and side effect burden at once.

Those Who May Benefit Most Are Stopping Most Often

The study authors emphasise that the same groups with elevated discontinuation risk, particularly younger people and socioeconomically disadvantaged individuals, also tend to carry a more severe obesity burden in Denmark. In other words, the people most likely to need sustained treatment are the ones least likely to maintain it. That makes this a health-equity finding as much as an adherence statistic.

Stopping Usually Means Leaving GLP-1 Therapy, Not Switching

After discontinuation, only 1.4% of patients moved to liraglutide and 0.7% to tirzepatide. This suggests that when people stop Wegovy, they generally leave the GLP-1 class rather than change products. For clinicians and payers, that means a discontinuation event is usually a full exit from therapy, not a switching moment.

Generalizing to the U.S. Requires Caution

The Danish findings are broadly consistent with U.S. studies showing discontinuation rates as high as 60% in the first year. But drug prices, insurance coverage, reimbursement policies and the availability of compounded products differ between the two countries. The study also lacks post-initiation weight-loss data and individual-level income and insurance details, so it cannot prove that stopping was the wrong choice in every case. Some patients may have met their goals and planned a short course from the start.

Practical Next Steps for Clinicians, Payers and Patients Managing Obesity Treatment

  • For clinicians: Discuss long-term cost and patient motivation before starting semaglutide. Low-income municipality patients had an 11% higher relative risk of stopping, and nearly half of all users stopped within 12 months.
  • For obesity programmes: Build follow-up around the highest-risk windows. Discontinuation reached 27% by 6 months and 39% by 9 months, and 25% of stoppers restarted within 3 months, so structured check-ins at months 3, 6 and 9 could distinguish temporary interruption from full exit.
  • For payers and health systems: Do not assume patients who stop Wegovy are switching to another GLP-1. Only 1.4% moved to liraglutide and 0.7% to tirzepatide, so coverage and support design should treat discontinuation as a likely exit from the class.
  • For patients considering treatment: Consider the financial commitment before starting and report gastrointestinal or psychiatric side effects early. Patients with prior gastrointestinal medication use had a 10% higher relative risk of stopping, which may be modifiable through slower dose titration.