Adverse Events of Glucagon-Like Peptide-1 Receptor Agonists for Obesity among South Korean Patients: A Prescription Sequence Symmetry Analysis

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Objective: The aim of this study was to evaluate the relationship between GLP-1 receptor agonists for obesity and selected adverse events in South Korea using Prescription Sequence Symmetry Analysis (PSSA).Methods: Prescription data from the Hubase Pharmacy Chain Network were used.New users of GLP-1 receptor agonists were defined as patients who received at least one prescription during the study period (liraglutide: 18.03.01-25.09.27; semaglutide: 24.10.01-25.09.27) with no prescription history of the corresponding drug during the 1-year washout period.Psychiatric and gastrointestinal adverse events were identified using marker medications.PSSA was performed to examine the relationship between initiation of GLP-1 receptor agonists and subsequent marker medication prescriptions by calculating adjusted sequence ratios (aSRs).Results: In the analysis of liraglutide and psychiatric marker medications, the aSR was 0.82 (95% CI: 0.52-1.29),showing no asymmetry in prescription sequences.For semaglutide, the aSR for psychiatric marker medications was 1.32 (95% CI: 0.81-2.13),suggesting a tendency toward increased prescribing after treatment initiation, although this was not statistically significant and was based on a limited number of prescription pairs.In analyses involving gastrointestinal marker medications, the aSRs were 0.65 (95% CI: 0.52-0.81)for liraglutide and 0.87 (95% CI: 0.69-1.10)for semaglutide, with no signals indicating an increased occurrence of gastrointestinal adverse events.Conclusion: No clear prescription sequence asymmetry signals were identified for psychiatric and gastrointestinal adverse events.This study highlights the utility of pharmacy dispensing data for drug safety signal detection in real-world data, while further research with longer observation periods and larger samples is warranted.(PeRM 2026;18:77-86)

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