Long term pharmacotherapy for obesity and overweight: updated meta-analysis

doi:10.1136/bmj.39385.413113.25

BMJ, doi: 10.1136/bmj.39385.413113.25, (Published 15 November 2007)

Research

Long term pharmacotherapy for obesity and overweight: updated meta-analysis

Diana Rucker, clinical fellow¹, Raj Padwal, assistant professor¹, Stephanie K Li, assistant clinical professor¹, Cintia Curioni, assistant professor², David C W Lau, professor³

¹ Department of Medicine, University of Alberta, Edmonton, AB, Canada, ² Department of Nutrition, Faculdade Arthur Sá Earp Neto, Petrópolis, Rio de Janeiro, Brazil, ³ Department of Medicine, University of Calgary, Calgary, AB, Canada

Correspondence to: R Padwal rpadwal{at}ualberta.ca

Objective To summarise the long term efficacy of anti-obesitydrugs in reducing weight and improving health status.

Design Updated meta-analysis of randomised trials.

Data sources Medline, Embase, the Cochrane controlled trialsregister, the Current Science meta-register of controlled trials,and reference lists of identified articles. All data sourceswere searched from December 2002 (end date of last search) toDecember 2006.

Studies reviewed Double blind randomised placebo controlledtrials of approved anti-obesity dugs used in adults (age over18) for one year or longer.

Results 30 trials of one to four years' duration met the inclusioncriteria: 16 orlistat (n=10 631 participants), 10 sibutramine(n=2623), and four rimonabant (n=6365). Of these, 14 trialswere new and 16 had previously been identified. Attrition ratesaveraged 30-40%. Compared with placebo, orlistat reduced weightby 2.9 kg (95% confidence interval 2.5 kg to 3.2 kg), sibutramineby 4.2 kg (3.6 kg to 4.7 kg), and rimonabant by 4.7 kg (4.1kg to 5.3 kg). Patients receiving active drug treatment weresignificantly more likely to achieve 5% and 10% weight lossthresholds. Orlistat reduced the incidence of diabetes and improvedconcentrations of total cholesterol and low density lipoproteincholesterol, blood pressure, and glycaemic control in patientswith diabetes but increased rates of gastrointestinal side effectsand slightly lowered concentrations of high density lipoprotein.Sibutramine lowered concentrations of high density lipoproteincholesterol and triglycerides but raised blood pressure andpulse rate. Rimonabant improved concentrations of high densitylipoprotein cholesterol and triglycerides, blood pressure, andglycaemic control in patients with diabetes but increased therisk of mood disorders.

Conclusions Orlistat, sibutramine, and rimonabant modestly reduceweight, have differing effects on cardiovascular risk profiles,and have specific adverse effects.

Add to CiteULike CiteULike Add to Complore Complore Add to Connotea Connotea Add to Del.icio.us Del.icio.us Add to Digg Digg Add to Reddit Reddit Add to StumbleUpon StumbleUpon Add to Technorati Technorati What's this?

Relevant Articles

Orlistat over the counter: Gareth Williams
BMJ 2007 335: 1163-1164. [Extract] [Full Text] [PDF]

Pharmacological and lifestyle interventions to prevent or delay type 2 diabetes in people with impaired glucose tolerance: systematic review and meta-analysis: Clare L Gillies, Keith R Abrams, Paul C Lambert, Nicola J Cooper, Alex J Sutton, Ron T Hsu, and Kamlesh Khunti
BMJ 2007 334: 299. [Abstract] [Full Text] [PDF]

Measuring inconsistency in meta-analyses: Julian P T Higgins, Simon G Thompson, Jonathan J Deeks, and Douglas G Altman
BMJ 2003 327: 557-560. [Extract] [Full Text] [PDF]

Pharmaceutical industry sponsorship and research outcome and quality: systematic review: Joel Lexchin, Lisa A Bero, Benjamin Djulbegovic, and Otavio Clark
BMJ 2003 326: 1167-1170. [Abstract] [Full Text] [PDF]

This article has been cited by other articles:

Sood, A., Ebbert, J. O., Clark, M. M., Croghan, I. T., Schroeder, D. R., Hays, J. T. (2009). Sibutramine for weight gain attenuation during smoking cessation with varenicline: A pilot study. Nicotine Tob Res 0: ntp162v2-ntp162 [Abstract] [Full text]
(2009). Over-the-counter weight loss with orlistat?. DTB 47: 125-127 [Abstract] [Full text]
Kyrou, I., Tsigos, C. (2009). Obesity in the Elderly Diabetic Patient: Is weight loss beneficial? No. Diabetes Care 32: S403-S409 [Full text]
Phelan, S., Nallari, M., Darroch, F. E., Wing, R. R. (2009). What Do Physicians Recommend To Their Overweight and Obese Patients?. J Am Board Fam Med 22: 115-122 [Abstract] [Full text]
Digenio, A. G., Mancuso, J. P., Gerber, R. A., Dvorak, R. V. (2009). Comparison of Methods for Delivering a Lifestyle Modification Program for Obese Patients: A Randomized Trial. ANN INTERN MED 150: 255-262 [Abstract] [Full text]
Idelevich, E., Kirch, W., Schindler, C. (2009). Current pharmacotherapeutic concepts for the treatment of obesity in adults. Ther Adv Cardiovasc Dis 3: 75-90 [Abstract]
Roberts, C. K., Barnard, R. J., Croymans, D. M., Astrup, A., Moller, K., Krogh-Madsen, R., Ornish, D., Manzoni, G. M., Castelnuovo, G., Molinari, E., Shai, I., Henkin, Y., Stampfer, M. J. (2008). Weight Loss with a Low-Carbohydrate, Mediterranean, or Low-Fat Diet. NEJM 359: 2169-2172 [Full text]
Ashrafian, H., le Roux, C. W., Darzi, A., Athanasiou, T. (2008). Effects of Bariatric Surgery on Cardiovascular Function. Circulation 118: 2091-2102 [Full text]
Bloomgarden, Z. T. (2008). American College of Endocrinology Pre-Diabetes Consensus Conference: Part Two. Diabetes Care 31: 2222-2229 [Full text]
Bray, G. A. (2008). Lifestyle and Pharmacological Approaches to Weight Loss: Efficacy and Safety. J. Clin. Endocrinol. Metab. 93: s81-s88 [Abstract] [Full text]
Bakhai, A. (2008). Adipokines--targeting a root cause of cardiometabolic risk. QJM 101: 767-776 [Abstract] [Full text]
Li, P. K.-T., Kwan, B. C.-H., Szeto, C. C., Ko, G. T.-C. (2008). Metabolic syndrome in peritoneal dialysis patients. NDT Plus 1: 206-214 [Abstract] [Full text]
Izzo, A A, Camilleri, M (2008). Emerging role of cannabinoids in gastrointestinal and liver diseases: basic and clinical aspects. Gut 57: 1140-1155 [Abstract] [Full text]
Shai, I., Schwarzfuchs, D., Henkin, Y., Shahar, D. R., Witkow, S., Greenberg, I., Golan, R., Fraser, D., Bolotin, A., Vardi, H., Tangi-Rozental, O., Zuk-Ramot, R., Sarusi, B., Brickner, D., Schwartz, Z., Sheiner, E., Marko, R., Katorza, E., Thiery, J., Fiedler, G. M., Bluher, M., Stumvoll, M., Stampfer, M. J., the Dietary Intervention Randomized Controlled Tri, (2008). Weight Loss with a Low-Carbohydrate, Mediterranean, or Low-Fat Diet. NEJM 359: 229-241 [Abstract] [Full text]
Wilding, J., Finer, N. (2008). Weight management and cardiovascular disease: implications of recent and ongoing clinical trials. British Journal of Diabetes & Vascular Disease 8: 170-176 [Abstract]
Garcia Ulen, C., Huizinga, M. M., Beech, B., Elasy, T. A. (2008). Weight Regain Prevention. Clin. Diabetes 26: 100-113 [Abstract] [Full text]
(2008). Surgery for obesity in adults. DTB 46: 41-45 [Abstract] [Full text]
Sharma, A. M. (2008). Response. cfp 54: 849-850 [Full text]
Buckley, P. F., Foster, A., Miller, B. (2008). Schizophrenia Host Vulnerability and Risk of Metabolic Disturbances During Treatment with Antipsychotics. Focus 6: 172-179 [Abstract] [Full text]
Bloom, S. R., Kuhajda, F. P., Laher, I., Pi-Sunyer, X., Ronnett, G. V., Tan, T. M.M., Weigle, D. S. (2008). The Obesity Epidemic: Pharmacological Challenges. Mol. Interv. 8: 82-98 [Abstract] [Full text]
Williams, G. (2007). Orlistat over the counter. BMJ 335: 1163-1164 [Full text]

Rapid Responses:

Read all Rapid Responses

Sibutramine and HDL: Tristan P Cooper
bmj.com, 16 Nov 2007 [Full text]
Orlistat does work: William J Coote
bmj.com, 16 Nov 2007 [Full text]
error in abstract: Raj Padwal
bmj.com, 17 Nov 2007 [Full text]
Rimonabant in overweight/obese patients: Andr� J Scheen, et al.
bmj.com, 30 Nov 2007 [Full text]
Rimonabant and Systolic Blood Pressure: Martin Neovius, et al.
bmj.com, 2 Jan 2008 [Full text]
Obesity at risk vs adiposity at risk: Is there a difference?: Jean-Pierre Despres, et al.
bmj.com, 30 Jan 2008 [Full text]
Re: Rimonabant and Systolic Blood Pressure: Raj S Padwal
bmj.com, 1 Feb 2008 [Full text]