As the morbidity and mortality of obesity have significantly increased, most current guidelines recommend pharmacotherapy as the second lin...
As the morbidity and mortality of obesity have significantly increased, most current guidelines recommend pharmacotherapy as the second line of treatment for this disorder following lifestyle modifications. Pharmacological treatment should be considered as part of a comprehensive strategy for the treatment of patients with a BMI ≥30 or ≥27 kg/m2 and an obesity-related comorbidity—HTN, T2DM, dyslipidemia, and sleep apnea. Additionally, the efficacy of medical treatment should be evaluated after the first 3 months of drug use. Substantial research has been dedicated to the development of a newer generation of anti-obesity drugs. In recent years, many novel agents have undergone phase III clinical trials. Compared to placebo, these drugs cause Young Jin Tak and Sang Yeoup Lee: An Updated Review on Anti-Obesity Drugs www.wjmh.org 217 Table 2. Data from meta-analyses of the anti-obesity drugs approved for long-term use for weight loss Drug Study (duration ≥1 year) Subject (drug/placebo) Lifestyle intervention (diet/exercise/behavior) Weighted mean difference (kg) (95% CI) for the drug-to-placebo comparison at 1 year % weight loss (drug/placebo) Odds ratio (95% CrI) for achieving ≥5% weight loss % of patients with ≥5% weight loss at 1 year (drug/placebo) % of patients with ≥10% weight loss at 1 year (drug/placebo)
Odds ratio (95% CrI) for discontinuation due to adverse event Orlistat 17 trials 5,572/5,572 Reduced fat intake or 500–800 kcal deficit/ non-specific increase or 30 minutes of moderate exercise per day/yes or no 2.60 (2.16–3.04) 4.6/1.7 2.70 (2.34–3.09) 48.8/22.6 17.9/8.8 1.84 (1.53–2.21) Phentermine/ topiramate 3 trials 1,802/1,735 500 kcal deficit/nonspecific increase/yes 8.80 (7.42–10.2) 8.5/1.7 9.22 (6.63–12.85) 72.0/22.8 49.7/8.6 2.29 (1.71–3.06) Naltrexone/ bupropion 5 trials 6,963/5,897 500 kcal deficit/nonspecific increase or 30 minutes of moderate exercise per day/yes 4.95 (3.96–5.94) 6.1/2.1 3.96 (3.03–5.11) 52.4/28.3 28.3/9.7 2.64 (2.10–3.35) Liraglutide 4 trials 3,096/1,649 500 kcal deficit/minimum 150 minutes of brisk walking per week/yes 5.27 (4.52–6.06) 7.1/1.7 5.54 (4.16–7.78) 60.3/24.6 30.4/8.4 2.95 (2.11–4.23) Lorcaserina 4 trials 9,453/9,440 600 kcal deficit/30 minutes of moderate exercise per day/yes 3.22 (2.46–3.97) 5.1/2.0 3.10 (2.38–4.05) 42.7/19.7 19.0/6.7 1.34 (1.05–1.76) CI: confidence interval, CrI: credible interval. aWithdrawn from the market for safety issue related to an increased cancer incidence in February 2020. https://doi.org/10.5534/wjmh.200010 218 www.wjmh.org a significant weight reduction, including meaningful improvements in cardiometabolic profiles, while demonstrating good tolerability and safety in patients with obesity. Data from most recent meta-analyses showed that the overall placebo-subtracted weight reduction (%) with the use of anti-obesity drugs for at least 12 months ranges from 2.9% to 6.8%; phentermine/topiramate (3 trials, -6.8%) liraglutide (4 trials, -5.4%), naltrexone/bupropion (5 trials; -4.0%), lorcaserin (4 trials; -3.1%), and orlistat (17 trials, -2.9%) (Table 2) [56,84-88]. Most prior trials conducted on these medications also performed an intensive consultation on diet and exercise in not only the placebo but also the treatment groups. Thus, these medications were proposed for use as pharmacotherapy in conjunction with healthy eating, physical activity, and behavior modification. Further, prior findings demonstrated that anti-obesity drugs cannot be used as a panacea for the treatment of obesity; instead, they should be used to facilitate weight control. Conflict of Interest The authors have nothing to disclose. Author Contribution Conceptualization: SYL. Investigation: SYL, YJT. 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