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Adipose Tissue_Appetite_and Obesity

MON-731 - Treatment Discontinuation, Exposure-Response Relationships and Cost-Efficiency of Tirzepatide in Routine Obesity Care

Monday, June 15, 2026
9:00 AM - 2:00 PM CT
Location: ENDOExpo; Poster Floor
Disclosure(s):
Rodis D. Paparodis, MD, FNLA: .NovoNordisk: Advisory Board (), Speakers' Bureau (); Ascendis Pharma: Advisory Board (), Grant Recipient (), Honorarium Recipient (); Sanofi: Advisory Board ()
Background
While randomized clinical trials have established the efficacy of tirzepatide for obesity management, real-world data on treatment persistence, exposure–response relationships, and economic efficiency remain limited. In routine clinical practice, individualized dose titration, tolerability, and out-of-pocket costs may substantially influence treatment outcomes.
Methods
This prospective, multicenter, real-world observational study included 95 adults with obesity initiating tirzepatide therapy and followed for 3 and 6 months. Treatment discontinuation patterns and reasons were recorded. Exposure–response relationships were explored using multivariable regression models assessing associations between cumulative tirzepatide dose and percentage weight loss, adjusted for baseline body weight, age, and sex. Cost-efficiency was evaluated using pragmatic real-world metrics, including cost per kilogram and cost per percentage body weight reduction, reflecting out-of-pocket expenses in a non-reimbursement setting.
Results
By 6 months, 25% of participants had discontinued treatment, most commonly due to adverse events, treatment cost, achievement of target body weight, or inadequate response. Cumulative tirzepatide dose was not independently associated with percentage weight loss at either 3 or 6 months. In contrast, higher baseline body weight consistently predicted greater relative weight loss. Cost-efficiency improved markedly over time among treatment completers, with median cost per kilogram of weight loss decreasing substantially between 3 and 6 months. Cumulative treatment cost was not correlated with achieved weight loss, indicating that higher individual expenditure did not translate into proportionally greater clinical benefit under real-world conditions.
Conclusions
In routine obesity care, treatment persistence and baseline patient characteristics appear to play a more important role in determining weight-loss outcomes than cumulative tirzepatide exposure. Economic efficiency improves with treatment continuation, highlighting the clinical and economic relevance of supporting persistence in self-funded treatment settings. These findings provide novel real-world insights into the practical implementation of tirzepatide beyond randomized trial environments.

*Unless otherwise noted, all abstracts presented at ENDO must not be released to the press or the public until the date and time of presentation. For oral presentations, the abstracts are embargoed until the session begins. The Endocrine Society reserves the right to lift the embargo on specific abstracts that are selected for promotion prior to or during ENDO.*