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Pharmacological Treatments for Obesity

JAMA; 2016 Jun 14; Khera, Murad, et al

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All 5 medications that have been approved for the management of obesity in adults, orlistat, lorcaserin, naltrexone-bupropion, phentermine-topiramate, and liraglutide were associated with achieving at least 5% weight loss after 1 year when compared to placebo. Phentermine-topiramate and liraglutide were associated with the highest odds of achieving this goal of 5% or greater weight loss. The meta-analysis of 28 randomized clinical trials included 29,018 patients (median age 46 years; 74% women; median baseline body weight, 100.5 kg; median baseline BMI, 36.1). Researchers found:

• A median 23% of placebo participants had at least 5% weight loss vs 75% of participants taking phentermine-topiramate (OR, 9.22), 63% taking liraglutide (OR, 5.54), 55% taking naltrexone-bupropion (OR, 3.96), 49% taking lorcaserin (OR, 3.10), and 44% taking orlistat (OR, 2.70).

• All active agents were associated with significant excess weight loss vs placebo at 1 year.

• Compared with placebo, liraglutide (OR, 2.95) and naltrexone-bupropion (OR, 2.64) were associated with the highest odds of adverse event-related treatment discontinuation.

Citation: Khera R, Murad M, Chandar AK, et al. Association of pharmacological treatments for obesity with weight loss and adverse events. A systematic review and meta-analysis. JAMA. 2016;315(22):2424-2434. doi:10.1001/jama.2016.7602.

Commentary: We saw recently that the prevalence of obesity continues to increase and that in 2013-2014, the age-adjusted prevalence of obesity was 38% overall, with 35% of men and 40% of women being classified as obese. While it is clear that primary prevention is paramount, and that lifestyle modification is the first-line approach for the treatment of obesity, lifestyle alone is not sufficient for achieving and sustaining weight loss in the majority of obese adults. The FDA has approved 5 weight loss drugs for long-term use in persons who are either obese (BMI ≥30), or who are overweight (BMI ≥27) with at least 1 weight-associated comorbidity (type 2 diabetes, hypertension, hyperlipidemia).1 This study helps us better understand the relative efficacy and side effects of the 5 FDA approved weight loss medications in order to better integrate them into use. —Neil Skolnik, MD

1. Yanovski SZ, Yanovski JA. Long-term drug treatment for obesity: a systematic and clinical review. JAMA. 2014;311(1):74-86. doi:10.1001/jama.2013.281361.

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