GLP-1 prescribing for individuals with schizophrenia-spectrum disorders in a safety net hospital.

OBJECTIVE: Glucagon-like peptide-1 receptor agonists (GLP-1 s) are a promising treatment to manage obesity and diabetes in people with schizophrenia-spectrum disorders (SSDs); however, little is known about real-world prescribing of these medications in SSDs. We examined the incidence of GLP-1 orders and antipsychotic prescription profiles among individuals with SSDs in a safety net hospital. METHODS: We used electronic health record data to capture GLP-1 and antipsychotic medication orders for individuals with SSDs. We calculated incidence rates of GLP-1 orders per 1000 person-years. Among GLP-1 recipients, we classified antipsychotic prescription profiles as: first generation antipsychotics (FGA), second generation antipsychotics (SGA) - higher metabolic liability, and SGA - lower metabolic liability. RESULTS: The incidence rate of GLP-1 orders increased 4-fold from 7.49 (95% CI: 3.43-14.22) per 1000 person-years in 2017 to 32.41 (95% CI: 25.06-41.23) per 1000 person-years in 2024. 64% of GLP-1 recipients were prescribed an antipsychotic in the year before GLP-1 initiation; 26% were prescribed SGA - higher metabolic liability, 29% were prescribed SGA - lower metabolic liability, and 9% were prescribed FGA. CONCLUSION: The incidence of GLP-1 prescriptions rose among individuals with SSDs in the safety net hospital from 2017 to 2024. Further, GLP-1 s were prescribed across the spectrum of antipsychotics.