Real-World Liraglutide Study Shows Meaningful Weight Loss in Taiwanese Adults at Sub-Maximal Doses

A landmark surveillance study conducted across 14 hospitals and clinics in Taiwan has delivered some of the clearest real-world evidence yet that liraglutide, the once-daily glucagon-like peptide-1 analogue better known by its brand names for diabetes and weight management, can drive clinically meaningful weight loss in adults with obesity even when patients never reach the dose that dominated the drug’s famous clinical trial program. The findings, drawn from 259 adults tracked between February 2024 and January 2025, arrive at a moment when GLP-1 receptor agonists have become the most talked-about class of medications in metabolic medicine, and they add a crucial twist to that story: in routine clinical practice, effectiveness and tolerability may depend less on pushing doses to their maximum and more on how long patients can afford to stay on treatment.

The research, a multicentre, single-arm, post-marketing surveillance study sponsored by Novo Nordisk Pharma Taiwan, was designed deliberately to escape the artificial conditions of randomised controlled trials. Trials in the global SCALE program, which established liraglutide 3.0 mg as an effective adjunct to reduced-calorie diet and increased physical activity, operated under strict titration schedules, intensive monitoring, and exclusion criteria that often screened out patients with complex comorbidities. Real-world clinics face a messier reality: patients who hesitate to escalate doses, who discontinue early, or who cannot shoulder the financial burden of chronic therapy. By enrolling adults who had independently chosen to start liraglutide under approved label use, the Taiwanese investigators captured a pragmatic benchmark of what the drug actually delivers in everyday care.

The pharmacology behind liraglutide explains why it has captured such attention. The molecule shares 97 percent homology with human GLP-1, a gut hormone released after eating that travels to brain regions including the hypothalamus and amygdala, where it is translated into satiety and reduced food intake. Peripheral administration of the drug decreases caloric consumption, delays gastric emptying, stimulates insulin secretion, suppresses inappropriate glucagon release, improves pancreatic beta-cell function, and modestly increases energy expenditure, with the resulting weight loss coming primarily from reductions in fat mass. In the five adult trials of the SCALE program, the 3.0 mg dose consistently induced mean weight loss exceeding five percent of baseline body weight, superior to lifestyle modification alone, and the safety profile mirrored that of the 1.8 mg diabetes formulation, with transient gastrointestinal events reported most frequently.

What the Taiwanese team found was striking in its deviation from trial conditions. The mean daily dose actually administered was just 1.4 mg, well below the 3.0 mg maintenance target, and only 32 of the 259 participants, roughly 12 percent, ever escalated to the full recommended dose. Among the 227 participants who did not reach 3.0 mg, nearly half, 127 individuals, cited medication cost as the primary reason, while only eight cited adverse reactions. Nevertheless, in participants who persisted with treatment, the weight losses were unambiguous. At 13 weeks, the mean reduction was 5.7 kg, or 6.3 percent of baseline body weight, and at 26 weeks it reached 8.5 kg, or 9.1 percent, with both findings statistically significant at p less than 0.0001.

The proportions of patients crossing clinically meaningful thresholds were equally compelling. Among those treated for around 26 weeks, 76.7 percent lost at least five percent of their baseline body weight and 38.3 percent lost at least ten percent, results that align with prior studies of Asian populations showing clinically significant reductions even with submaximal doses over shorter treatment periods. The study population itself reflected the changing face of obesity in Taiwan, where adult obesity prevalence has climbed from 11.8 percent in the mid-1990s to 23.9 percent by 2020. Sixty-one percent of participants were women, the mean age was 42 years, the mean baseline BMI was 33.0 kg per square metre, and comorbidities were common, including dyslipidaemia in 38 percent, hepatic impairment in 27 percent, hypertension in 26 percent, and diabetes in 21 percent.

On safety, the surveillance data painted a picture arguably more favourable than the trial literature, though the investigators urge caution in direct comparison. Only 29 participants, 11.2 percent, experienced any adverse event, with 44 events recorded in total. Gastrointestinal disorders, classically the dominant side effect of GLP-1 therapy, accounted for just 2.3 percent of the cohort, comprising constipation, nausea, abdominal distension, diarrhoea, and stomatitis, and no gastrointestinal event progressed to serious complications such as cholelithiasis, cholecystitis, or pancreatitis. General disorders and injection-site conditions, including erythema, dermatitis, hypersensitivity, and pruritus, were the most frequent category at 4.3 percent. Only three events were rated moderate and one severe, no serious adverse drug reactions were documented, and only eight participants discontinued treatment because of intolerable adverse events.

The investigators attribute the low event rates to several converging factors. Lower doses plausibly produce fewer dose-dependent effects, consistent with exposure-response analyses showing that higher liraglutide concentrations correlate with more nausea and vomiting. Slower, more flexible titration schedules chosen by clinicians may have allowed patients to develop better tolerance. Spontaneous reporting in observational settings likely under-documented mild events, and the large proportion of participants, nearly 46 percent, who withdrew before week 13 may have removed transient adverse events from the final tally. The shorter 26-week duration, compared with the 52 to 56 weeks of pivotal trials, may also have excluded late-onset serious events. Notably, subgroup analyses found no statistically significant differences in adverse event incidence across sex, age, comorbidities, hepatic impairment, or concomitant use of other anti-obesity medications, suggesting a consistent safety profile across patient types.

Beyond weight, the study detected a moderate reduction in blood pressure, more pronounced in systolic pressure, corroborating earlier liraglutide findings. Physiological studies suggest a mechanism rooted in renal GLP-1 receptor activation, which promotes urinary sodium excretion and natriuresis. Given that the mean baseline systolic pressure in this cohort, 134.8 mmHg, exceeded that of previous trials, the authors suggest liraglutide holds potential for integration into hypertension management for adults with obesity in Taiwan, and possibly a broader role in cardiovascular comorbidities associated with chronic metabolic disease, such as coronary artery disease.

Perhaps the most consequential finding is economic rather than pharmacological. With cost, not tolerability, driving both dose limitation and discontinuation, the study highlights an urgent need for health financing reform, including possible National Health Insurance subsidies for GLP-1 receptor agonists approved for weight loss in Taiwan. Modelled projections suggest these drugs may reduce lifetime societal costs of obesity, though comparative analyses in the United Kingdom and the United States have found newer agents such as semaglutide and tirzepatide more cost-effective than liraglutide. The authors acknowledge their study’s limitations, including the absence of a control group, per-protocol analysis that may overestimate effectiveness, attrition bias, and a short observation window, but they conclude that submaximal liraglutide doses achieved weight reductions comparable to the 3.0 mg dose in prior trials while reducing adverse events and financial burden, a combination that could reshape how this class of drugs is prescribed, priced, and sustained in the world’s fastest-growing obesity epidemic.

Subject of Research: A multicentre post-marketing surveillance study evaluating the real-world safety and effectiveness of liraglutide for weight management in adults with obesity in Taiwan.

Article Title: Liraglutide in Adults With Obesity: A Multicentre, Single‐Arm, Post‐Marketing Surveillance Study in Taiwan

Article References: Liraglutide in Adults With Obesity: A Multicentre, Single‐Arm, Post‐Marketing Surveillance Study in Taiwan. (n.d.). https://doi.org/10.1002/edm2.70333

Image Credits: AI Generated

DOI: 10.1002/edm2.70333

Keywords: liraglutide, obesity, GLP-1 receptor agonist, weight loss, Taiwan, post-marketing surveillance, anti-obesity medication, real-world evidence, gastrointestinal adverse events, medication cost, blood pressure, type 2 diabetes