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The number of adolescents and young adults prescribed a glucagon-like peptide-1 (GLP-1) receptor agonist increased nearly 600% over the past few years, pharmacy data indicated.

From 2020 to 2023, the number of individuals ages 12 to 25 years who received a prescription for the diabetes or weight-loss drugs grew from 8,722 to 60,567 per month, representing a 594.4% increase, reported Joyce M. Lee, MD, MPH, of the University of Michigan Medical School in Ann Arbor, and colleagues.

As a point-of-reference, the prescription rate of all other pharmacy drugs doled out to individuals in this age group decreased by 3.1% during the same timeframe, the study authors noted in their research letter.

"The rapid increase in dispensing suggests significant demand for this medication among younger populations," Lee told MedPage Today.

There were stark jumps in GLP-1 agonist dispensing across the board, but girls and young women accounted for a majority of the prescription fills during the study period.

"We suspected there would be an increase in GLP-1 medication dispensing," Lee said. "I think we were surprised that the increases in GLP-1 dispensing were more pronounced among females than among males. For example, in 2023, 60% of adolescents dispensed medications were female and 76.4% of young adults dispensed medications were female."

"This disproportionate dispensing may reflect a societal bias towards weight in females," she suggested.

Agents included in the analysis were dulaglutide (Trulicity), exenatide (Byetta, Bydureon), liraglutide (Victoza, Saxenda), semaglutide (Ozempic, Rybelsus, Wegovy), and tirzepatide (Mounjaro, Zepbound), a dual GLP-1 and glucose-dependent insulinotropic polypeptide (GIP) receptor agonist.

Currently dulaglutide and exenatide are approved for adolescents and adults with type 2 diabetes, while liraglutide and semaglutide are approved for both diabetes and weight management in adult and pediatric patients. Tirzepatide is approved for diabetes and weight management in adults only.

"Despite the fact that GLP-1 [receptor agonist] medications like Wegovy were approved by the FDA for weight loss in adults in 2021 and adolescents in 2022, little is known about the use of these medications in younger patients," Lee said.

The group's analysis used data from the IQVIA Longitudinal Prescription Database, which represented 93.6% of U.S. retail pharmacies. From 2020 to 2023, there was a 503.8% increase in monthly GLP-1 agonist dispensing among male adolescents (from 692 to 4,178 per month) and a 587.5% increase among female adolescents (from 961 to 6,607). As for young adults, there was a 481.1% increase in monthly GLP-1 agonist dispensing among men (from 2,180 to 12,667) and 659.4% increase for women (from 4,886 to 37,111).

Dulaglutide, exenatide, and liraglutide prescriptions started off and remained the most common among adolescents. However, there was a sharp increase in semaglutide prescriptions for weight management in January 2023 after its late-2022 approval for this age group.

In young adults on the other hand, dulaglutide, exenatide, and liraglutide prescriptions started off as the most common as well, but were quickly overtaken by semaglutide and tirzepatide in early 2023.

Prescribing data for 2023 included 30,947 adolescents (ages 12-17) and 162,439 young adults (ages 18-25). Nearly half of adolescents and young adults dispensed a GLP-1 receptor agonist lived in the South. Adolescents most often had Medicaid (48%) covering their GLP-1 agonists, followed by commercial insurance (43.7%). Young adults most often had commercial insurance (66.8%) followed by Medicaid (26.3%).

Endocrinologists were the most common prescriber of GLP-1 agonists for adolescents (32.7%), followed by nurse practitioners (26.4%) and family medicine providers (12.3%). As for young adults, they were most often prescribed a GLP-1 agonist by nurse practitioners (33%), followed by family medicine providers (22.9%) and endocrinologists (13.7%).

"Efforts to promote safe and appropriate prescribing should include endocrinologists, family medicine physicians, and nurse practitioners given their prominent roles in GLP-1 receptor agonist dispensing," the researchers advised. Lee said that given a shortage of endocrinologists and obesity medicine specialists, primary care physicians likely will need more education and training focused on using this class of medications.

She added that we also need more information about the long-term side effects and effectiveness of these medications with indefinite use, especially as these agents become more commonly used in young patients.

"We also have to think about additional risks for younger individuals who are of reproductive age," Lee said. "In females, the GLP-1 receptor agonists should not be taken during pregnancy or while breastfeeding and female patients should be counseled that the medications may make birth control pills less effective."

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