1. In this meta-analysis, orlistat, lorcaserin, naltrexone-bupropion, phentermine-topiramate, and liraglutide all had a statistically significant odds ratio of achieving 5% weight loss when compared to placebo.
2. Phentermine-topiramate had greater odds of achieving both 5% and 10% weight loss than other medications and had no increased occurrence of adverse events.
Evidence Rating Level: 2 (Good)
Study Rundown: Obesity is an important public health problem in the United States and internationally. One strategy to combat obesity is oral medications to assist individuals with weight loss. This meta-analysis included randomized controlled trials (RCTs) of the five FDA approved oral medications for obesity (orlistat, lorcaserin, naltrexone-bupropion, phentermine-topiramate, and liraglutide) to compare their efficacy for weight loss and side effect profiles. Outcomes were assessed at one year and the primary weight loss outcome was 5% reduction in weight (a level of weight loss deemed clinically significant by the FDA). Twenty-eight trials were included in the study, and all five agents were associated with a greater odds of achieving at least 5% weight loss when compared to placebo. Additionally, phentermine-topiramate had greater odds of achieving both 5% and 10% weight loss than other medications and had no increased occurrence of adverse events.
The strengths of this study include the use of only RCTs and the standardized data extracted from each study. However, it is limited by its use of network meta-analyses to compare agents against one another, and the primary endpoint at only 1 year. Ultimately, this study suggests that oral medications can assist individuals in achieving weight loss. However, more RCTs comparing medications directly over longer periods are needed to better understand the effect of oral medications on obesity.
Click to read the study, published today in JAMA
Relevant Reading: Long-term drug treatment for obesity: a systematic and clinical review.
In-Depth [meta-analysis]: This meta-analysis compared the efficacy of the five FDA approved oral medications for obesity (orlistat, lorcaserin, naltrexone-bupropion, phentermine-topiramate, and liraglutide) on their effectiveness in achieving 5% weight loss and the occurrence adverse effects. For odds of achieving weight loss compared to placebo, orlistat had an OR of 2.70 (95%CI 2.34-3.09), lorcaserin an OR of 3.10 (95%CI 2.35-4.05), naltrexone-burpopion an OR of 3.95 (95%CI 3.03-5.11), phentermine-topiramate an OR of 9.22 (95%CI 6.63-12.85), and liraglutide an OR of 5.54 (95%CI 4.16-7.78). Phentermine-topiramate had greater odds of achieving both 5% and 10% weight loss at 52 weeks than other medications and was not associated with an increase in adverse events.
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