Agreement: I Agree Body: Dear Editor GLP-1 discontinuation: treatment cessation is not treatment failure The association between GLP-1 receptor agonist discontinuation and increased cardiovascular events is concerning, although the interpretation deserves closer scrutiny. The difference in all-cause mortality (2.2 versus 0.5 deaths per 100 person-years) is particularly striking, given the relatively modest changes in weight, glycaemic control and blood pressure. Without understanding why patients discontinued treatment, it is difficult to establish whether these findings reflect the loss of pharmacological protection, deteriorating health or other factors influencing treatment persistence. More importantly, discontinuation should not be regarded as a uniform clinical event. There is a considerable difference between patients who stop because of illness, intolerance or financial pressures and those who discontinue following sustained improvements in their metabolic health. Evidence suggests that what patients achieve during treatment may influence their ability to maintain weight loss afterwards. Jensen and colleagues found that participants who combined supervised exercise with liraglutide maintained greater weight loss one year after treatment cessation than those receiving liraglutide alone.[1] Although this was a relatively small post-treatment analysis, it raises an important question about the contribution of structured lifestyle intervention to longer-term outcomes. In clinical practice, we devote considerable attention to initiating and adjusting pharmacotherapy, yet often provide comparatively little structured support to help patients develop the physical fitness, dietary habits and behavioural skills necessary to maintain their improvements. Weight loss achieved through medication does not, in itself, establish these capabilities. The cardiovascular benefits of GLP-1 receptor agonists in type 2 diabetes are well established, and there is no evidence that lifestyle intervention can necessarily replace this protection. Nevertheless, it would be unfortunate if observational evidence of poorer outcomes following discontinuation reinforced an assumption that indefinite pharmacotherapy is the only realistic option. We should be investigating which patients can safely discontinue treatment, what distinguishes them from those who cannot, and whether the quality of support provided during treatment influences that outcome. The success of GLP-1 treatment should not be judged solely by what happens while patients remain on medication, but also by the health improvements and capabilities they retain when treatment ends. References 1 Jensen SBK, Blond MB, Sandsdal RM, et al. Healthy weight loss maintenance with exercise, GLP-1 receptor agonist, or both combined followed by one year without treatment: a post-treatment analysis of a randomised placebo-controlled trial. eClinicalMedicine. 2024;69:102475. https://doi.org/10.1016/j.eclinm.2024.102475 2 Ceriello A, Prattichizzo F, Lucisano G, et al. GLP-1 receptor agonist discontinuation and cardiovascular events and all-cause mortality in people with type 2 diabetes: a retrospective cohort study. Lancet Regional Health – Europe. 2026. https://doi.org/10.1016/j.lanepe.2026.101881 No competing Interests: Yes The following competing Interests: Electronic Publication Date: Wednesday, November 11, 2026 - 09:14 AI use: No, I have not used AI Highwire Comment Subject: Stopping GLP-1 treatment could double risk of heart attack, stroke, or death, study finds Workflow State: Released Full Title: Re: Stopping GLP-1 treatment could double risk of heart attack, stroke, or death, study finds Highwire Comment Response to: Check this box if you would like your letter to appear anonymously:: Last Name: Robson First name and middle initial: Samantha Email: sam.robson@templeclinic.co.uk Address: Aberdeen Occupation: GP and Medical Director Affiliation: Temple Clinic BMJ: Additional Article Info: Rapid response
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