英国超百万自费超重/肥胖成人中替尔泊肽涨价前后的真实世界治疗模式与体重结局
采用分段中断时间序列分析2025年9月替尔泊肽涨价最高170%前后的启动和转换变化，并用线性混合效应模型估计体重轨迹。结果显示替尔泊肽组12个月体重下降19.93%，司美格鲁肽组下降16.40%。
要点
- 替尔泊肽宣布涨价后，司美格鲁肽启动比例显著增加31.15个百分点。
- 替尔泊肽转换为司美格鲁肽的比例增加9.26个百分点，随后减弱。
- 12个月时替尔泊肽组估计体重下降19.93%，司美格鲁肽组下降16.40%。
核心结论
- 单一英国远程医疗平台在超重或肥胖成人中实现了较大规模覆盖。
- 替尔泊肽涨价前后，治疗启动和药物转换模式发生明显变化。
- 在有限辅助生活方式支持背景下，有随访数据的患者中观察到显著长期体重下降。
研究设计与样本
- 回顾性队列研究，纳入2024年5月1日至2026年1月1日通过MedExpress启动司美格鲁肽或替尔泊肽的成人。
- 采用分段中断时间序列模型分析治疗启动和转换变化，并设置2025年8月预期变化的敏感性分析。
- 采用线性混合效应模型估计体重轨迹。
主要发现
- 该平台在女性中的覆盖高于男性。
- 2025年9月司美格鲁肽启动比例较中断前预计趋势增加31.15个百分点（95% CI：26.07–36.24）。
- 替尔泊肽转换为司美格鲁肽的比例增加9.26个百分点（95% CI：7.09–11.42），随后减弱。
- 敏感性分析支持2025年8月存在预期性变化。
临床怎么用
- 在自费场景中，药物相对价格变化可显著影响超重或肥胖患者的治疗起始和转换选择。
- 远程医疗平台可作为大规模超重或肥胖人群GLP-1受体激动剂治疗的可及路径。
局限性
- 体重轨迹估计仅基于有随访数据的患者，可能存在选择偏倚。
- 研究基于单一英国远程医疗平台，结果外推到其他场景需谨慎。
以上解读依据论文摘要（全文未开放获取或许可不允许翻译转载）。
原文
ABSTRACT Aims Glucagon-like peptide-1 (GLP-1) receptor agonist-based medicines are highly effective treatments for overweight and obesity, but population-scale real-world evidence remains limited, particularly in self-funded settings where treatment choice may be influenced by relative price. We aimed to characterise provider reach and treatment patterns through a large United Kingdom (UK) telehealth provider, assess changes around the September 2025 tirzepatide list-price increase of up to 170%, and estimate longitudinal weight trajectories. Materials and Methods A retrospective cohort study of adults initiating semaglutide or tirzepatide through MedExpress from 1 May 2024 to 1 January 2026 was conducted. Treatment initiation and switching were analysed using segmented interrupted time-series models, with sensitivity analyses addressing anticipatory changes in August 2025. Weight trajectories were estimated using linear mixed-effects models. Results Among 1 033 522 adults, 932 659 (90.2%) initiated tirzepatide and 100 863 (9.8%) semaglutide; provider reach was higher among women than men. In September 2025, semaglutide initiation increased by 31.15 percentage points (95% CI: 26.07–36.24) relative to the projected pre-interruption trend. Tirzepatide-to-semaglutide switching increased by 9.26 percentage points (95% CI: 7.09–11.42) and subsequently attenuated. Sensitivity analyses supported anticipatory changes in August. At 12 months, estimated weight loss was 19.93% with tirzepatide (95% CI: 19.88–19.98; n = 30 763) and 16.40% with semaglutide (95% CI: 16.16–16.64; n = 979). Conclusions A single UK telehealth provider achieved substantial reach among adults with overweight or obesity. Treatment initiation and switching changed markedly around the tirzepatide price increase. Substantial longitudinal weight loss was observed among patients contributing follow-up in the context of limited adjunctive lifestyle support.
引用
- Diabetes, Obesity and Metabolism：Real‐World Treatment Patterns and Weight Outcomes Before and After a Tirzepatide Price Increase in Over One Million Self‐Paying UK Adults With Overweight or Obesity
供执业医师工作参考，不替代临床判断；数值与分级以指南原文为准。