Clinical outcomes associated with anti‐obesity medications in real‐world practice: A systematic literature review

Abstract

Anti-obesity medications (AOMs) are efficacious and well tolerated in randomized controlled trials, but findings may not be generalizable to routine clinical practice.This systematic literature review aimed to identify real-world (RW) evidence for AOMs to treat adults ( ≥ 18 years) with obesity or overweight (BMI ≥ 27 kg/m 2 ).Searches conducted in MEDLINE, Embase, Health Technology Assessment (HTA) Database, National Health Service (NHS) Economic Evaluation Database, and Cochrane Central Register of Controlled Trials for studies of relevant FDA-approved AOMs yielded 41 publications. Weight loss (WL) was consistently observed, with 14% to 58.6% of patients achieving ≥ 5% WL on orlistat, phentermine/topiramate, naltrexone/bupropion, phentermine, or liraglutide in studies of 3-6 months' duration where this was measured. When cardiometabolic risk factors were assessed, AOMs reduced or had no impact on blood pressure, lipids, or glycemia. RW data on the impact of AOMs on existing obesity-related comorbidities and mortality were generally lacking. AOMs were associated with various adverse events, but these were of mild to moderate severity and no unexpected safety signals were reported. A pattern of poor adherence and persistence with AOMs was observed across studies. Overall, the review confirmed the effectiveness of AOMs in RW settings but demonstrated large gaps in the evidence base.

Adherence to and Dropout from Liraglutide 3.0 mg Obesity Treatment in a Real-World Setting

“…16 Among the anti-obesity drugs, liraglutide is considered to have a lower risk of discontinuation than other drugs such as lorcaserin, naltrexone/bupropion, phentermine/topiramate, phentermine, and orlistat. 12,17 In randomized controlled trials of liraglutide, the dropout rate at 1 year ranged from 20% to…”

“…Studies on adherence to anti-obesity medication remain scarce, and the few that have been conducted indicate that adherence is generally poor and varies significantly among drug types. 12 Therefore, we assessed the rate and causes of non-adherence among people with obesity who were treated with liraglutide 3.0 mg in a real-world setting in Korea.…”

Obesity and Endothelial Function

“…Despite the proven effectiveness of bariatric surgery and anti-obesity drugs for reducing weight, only 0.4% of eligible patients undergo bariatric surgery and the rate of prescriptions of anti-obesity medications remains very low (0.28% in 2016) [ 184 , 185 ]. In addition, a real-world study showed that adherence and persistence with anti-obesity drugs are poor [ 186 ]. These current data may show a missed opportunity for reduction in cardiovascular risk through comprehensive weight reduction strategies in obese individuals.…”

Effect of semaglutide and liraglutide in individuals with obesity or overweight without diabetes: a systematic review

“… 12 , 31 Several systemic reviews and meta-analyses have compared weight loss among these five drugs except semaglutide, and have demonstrated that liraglutide was associated with the highest odds of achieving at least 5% weight loss compared to the others. 32 , 33 Some studies found that semaglutide was more effective in reducing body weight than liraglutide; however, the vast majority of these studies are studies based on patients with diabetes, with weight loss not being the main primary outcome. 34 – 36 Compared to patients with diabetes, obese/overweight individuals without diabetes should be assessed for the therapeutic outcomes as a unique group because of the different metabolic risks for the disease progression.…”