644-P: Racial Ethnic Disparities in Prescription of GLP-1 Receptor Agonists for People at High Risk for Diabetes on Atypical Antipsychotics

Introduction: Atypical antipsychotics (AAP) significantly increase the risk of obesity and type 2 diabetes (T2D). GLP-1 receptor agonists (GLP-1 RA) are weight-loss medications which may be beneficial in treating AAP-induced weight gain. We evaluated trends in prescriptions of GLP-1 RA among patients at high risk of T2D using AAP stratified by race-ethnicity. Methods: We modeled covariate-adjusted trends in GLP-1 RA (liraglutide, semaglutide) prescriptions between January 2019-November 2023 from the Epic Cosmos dataset among a real-world cohort at high risk of T2D on AAP. We included 121,493 adults (18-99 years) with obesity or overweight (BMI ≥ 27kg/m2) and weight-related comorbidity (hypertension or hypercholesterolemia). We report trends in GLP-1 RA prescriptions by race-ethnicity (Hispanic, Non-Hispanic [NH] White, NH Black, NH Other). Results: The analytic sample was 59.0% female, 72.2% NH White, 16.2% NH Black, and 5.8% Hispanic with mean age of 51.4 (SD: 19.2) years. There were no differences by race-ethnicity in 2019. However, in 2023 relative to NH White patients (2.2% [95% CI: 1.4, 3.1]), prescriptions were lower for NH Black (-1.1% [-2.8, 0.1]), Hispanic (-1.5% [-2.7, 0.0]) and NH Other (-1.2% [-2.7, 0.0]), Figure. Conclusion: There are emerging racial-ethnic disparities and underuse of effective weight loss medications among patients treated with AAP.