Socioeconomic and demographic inequalities in off-label prescription of glucagon-like peptide-1 (GLP-1) receptor agonists - a Swedish descriptive cohort study.

Introduction In Sweden, glucagon like peptide-1 (GLP-1) receptor agonists are subsidized for diabetes indication but not for obesity. Unregulated off-label prescription of GLP-1 receptor agonists for obesity treatment may raise concerns about potential inequalities for both patient groups. This study aims to describe socioeconomic and demographic characteristics of on- and off-label users of GLP-1 receptor agonists in persons without a diagnosis of diabetes. Methods Swedish descriptive register-based cohort study of persons who filled a prescription of a GLP-1 receptor agonist at least once during 2018-2022. Individuals were excluded from the study population if they had a diagnosis of diabetes or previous prescription fills of insulin/analogs at any time prior to the first filled prescription of a GLP-1 receptor agonist. Socioeconomic and demographic characteristics were described overall and stratified by sex and prior use of anti-obesity medications. Off-label use was defined by filled prescriptions of GLP-1 receptor agonists which are indicated for diabetes treatment. Results The study population included 16,436 individuals, of which 70.1% were women, 30.7% had previously filled a prescription of anti-obesity medications, 65.3% had Sweden as country of origin and 17.2% an Asian country. In the analyses stratified by sex women were more likely to have an education longer than 9 years (84.8% vs 78.3% in men). Nonetheless, women had lower annual individual (2891.3 vs 4004.9 in men) and family disposable income (5645.5 vs 6092.5 in men). Overall, on-label prescription was higher in women (49.2% vs 30.9% in men), while off-label was more common among men (69% vs 51% in women). Conclusion High family disposable income, and male sex are common among off-label glucagon-like peptide-1 receptor agonist users compared to users of the only on-label glucagon-like peptide-1 receptor agonist in Sweden. Regional differences indicate different clinical practices and guideline interpretations.