Long-term Drug Treatment for Obesity: A Systematic and Clinical Review
By S. Yanovski, J. Yanovski. Journal of the American Medical Association (JAMA), 2014
894 citations recorded by the source corpus.
Importance Thirty-six percent of US adults are obese and many cannot lose sufficient weight to improve health with lifestyle interventions alone. Objective Conduct a systematic review of medications currently approved in the US for obesity treatment in adults. We also discuss off-label use of medications studied for obesity and provide considerations for obesity medication use in clinical practice. Evidence Acquisition A PubMed search from inception through September, 2013 was performed to find meta-analyses, systematic reviews, and randomized, placebo-controlled trials for currently-approved obesity medications lasting ≥1y, that had a primary or secondary outcome of body weight, included ≥50 participants per group, reported ≥50% retention, and reported results on an intention-to-treat basis. Studies of medications approved for other purposes but tested for obesity treatment were also reviewed. Results Obesity medications approved for long-term use, when prescribed with lifestyle interventions, produce additional weight loss relative to placebo ranging from approximately 3% of initial weight for orlistat and lorcaserin to 9% for top-dose (15/92mg) phentermine/topiramate-ER at 1y. The proportion of patients achieving clinically-meaningful (≥5%) weight loss ranges from 37–47% for lorcaserin, 35–73% for orlistat, and 67–70% for top-dose phentermine/topiramate-ER. All three produce greater improvements in many cardiometabolic risk factors than placebo, but no obesity medication has been shown to reduce cardiovascular morbidity or mortality. Most prescriptions are for noradrenergic medications, despite their approval only for short-term use and limited data for their long-term safety and efficacy. Conclusions/Relevance Medications approved for long-term obesity treatment, when used as an adjunct to lifestyle intervention, lead to greater mean weight loss and an increased likelihood of achieving clinically-meaningful 1-year weight loss relative to placebo. By discontinuing medication in patients who do not respond with weight loss ≥5%, clinicians can decrease their patients' exposure to the risks and costs of drug treatment when there is little prospect of long-term benefit.
Subfields: Endocrinology, Diabetes and Metabolism, Pharmacology, Surgery
View Paper: https://www.semanticscholar.org/paper/7ee4fcc35fda0c98e6d57866953f1565f8a26475
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In Endocrinology, Diabetes and Metabolism
- H. Murad
- I. S. Farooqi
- J. Yanovski
- Janet Silverstein
- Silva Arslanian
- Dennis Styne
- E. Connor
- R. Loomba
In Pharmacology
In Surgery
Citations in the corpus
- Pediatric Obesity-Assessment, Treatment, and Prevention: An Endocrine Society Clinical Practice Guideline. (2017, positive): “Clinicians should be aware that no obesity medication has been shown to reduce the incidence of cardiovascular morbidity or mortality (267).”
- Pharmacological management of obesity: an endocrine Society clinical practice guideline. (2015, background): “Whatever baseline behavioral treatment is given, the effect of the drug will be static (33, 34).”
- Weight regain and cardiometabolic effects after withdrawal of semaglutide: The STEP 1 trial extension (2022, neutral): “In people with obesity, pharmacotherapy is indicated as an adjunct to lifestyle intervention for chronic weight management and can help with achieving and maintaining weight loss.(2,11,12) Long-term obesity pharmacotherapy may be required for weight maintenance, as cessation of pharmacological treat”
- Association of Pharmacological Treatments for Obesity With Weight Loss and Adverse Events (2016, methodology): “These were based on (1) use of an alternative statistical approach (random-effects frequentist model)21; (2) restricting only to studies in adults without diabetes (because antidiabetic medications may have independent weight-modifying effects); and (3) replacing trials of high-dose phentermine-topi”