Flexible dose of semaglutide reduces early discontinuation while maintaining comparable outcomes in obese patients: FLEX-SEMA 2.4 mg, an Italian real-world study.

AIMS: To evaluate real-world clinical use of semaglutide in obese patients, focusing on titration, tolerability and short-term efficacy. MATERIALS AND METHODS: This retrospective study included obese patients treated with the weekly injectable semaglutide. Data on body weight, waist circumference, lipid profile, doses, reasons for maintenance, adverse events, and discontinuations were collected at 3 and 6 months. RESULTS: A total of 111 patients were included (80% women; mean age 51.12; median body mass index (BMI) 35.56 kg/m; median body weight 97.00 kg). About 81.1% of patients initiated therapy at 0.25 mg, while 72.1% increased to 1 mg after 3 months. By 6 months, 2% remained on 0.5 mg, 40% on 1 mg, and 26% on 2.4 mg. The main reasons for maintaining the dose were satisfaction with the outcomes, followed by cost and adverse events. Significant reductions in weight, BMI, waist circumference and waist-to-height ratio were observed at both time points, with greater improvements seen in patients with a baseline BMI of ≥35. Weight loss of ≥5%, ≥10%, ≥15% and ≥20% was achieved by 23.5%, 34.6%, 30.8% and 11.1% of patients, respectively. There were no differences by sex, previous treatment or final dose. Adverse events occurred in 56.8% of patients at 3 months, leading to discontinuation in three patients. This percentage halved by 6 months (a 32.6% rate), with two cases leading to discontinuation. The rate of early discontinuation was 6.3% at 3 months, rising to 10.5% at 6 months due to cost, adverse events, or inefficacy. CONCLUSION: This real-world analysis provides valuable insights into the use of semaglutide in routine clinical practice, confirming a favourable efficacy profile with flexible dosing patterns.