BACKGROUND: Glucagon-like peptide 1 receptor agonists have shown promising results in obesity treatment. In France, semaglutide 2.4-mg (Wegovy) has benefited from an early-access program from July 2022 to September 2023. OBJECTIVE: This study aimed to describe the user profile of semaglutide 2.4-mg and the dosage patterns under real-world conditions during this period. METHODS: Between July 2022 and September 2023, semaglutide 2.4-mg initiators were identified through the nationwide APMO database (Accès Précoce-Médicaments Onéreux), built from the French National Health Data System (SNDS). The cohort was followed up until 31 December 2023. A sequence analysis was used to build clusters of dose escalation regimens. RESULTS: Among the 6990 adult patients who started treatment, the median age was 49.0 years, with a majority of women (65.8%). The study revealed significant regional variations in initiation rates, with the highest in Ile-de-France (including Paris). Three groups of users were identified: standard adherence (74.5%), early discontinuation (13.0%), and high-dose initiation (12.5%). Factors influencing these clusters included age, with younger patients (25-34 years) more likely to discontinue early (odds ratio: 1.35 [95% confidence interval 1.05-1.75]). The use of anti-emetics during the first 5 months of the follow-up period was higher in the early-discontinuation group (15.7%) compared with the high-dose initiation group (9.0%) and standard adherence group (12.3%). CONCLUSIONS: This study involved a substantial number of real-life semaglutide 2.4-mg users and highlights the importance of monitoring treated patients from a public health perspective, given the broad prescription to come and the potential risks associated with misuse.