Lorcaserin vs. Phentermine among non-surgical and surgical obese patients: Anthropometric, glycemic, lipid, safety and cost outcomes

Abstract

Background To evaluate effectiveness, safety, and costs of Lorcaserin vs. phentermine among obese non–surgical and surgical patients (post bariatric surgery). Methods This retrospective study retrieved charts of all patients (January 2013–June 2016) who received Lorcaserin or phentermine for 3 months. The study assessed anthropometric, glycemic, and lipid changes, as well as side effects and cost of medications among overweight and obese non-surgical (n = 83) and surgical patients (n = 46). These two patient groups were compared using Chi-square (χ2) and unpaired‘t’ test for qualitative and quantitative variables respectively. Results At 3 months, among the non-surgical group, Phentermine patients had greater percentage of total weight loss (TWL%) (7.65 ± 8.26 vs. 2.99 ± 3.72%, P = 0.003), and greater BMI reduction (−3.16 ± 3.63 vs. −1.15 ± 1.53 kg/m 2 , P = 0.003) than Lorcaserin. Within the surgical group, Lorcaserin patients had significantly smaller TWL% (1.86 ± 5.06 vs. 7.62 ± 9.80%, P = 0.012), and smaller BMI reduction (−0.74 ± 1.80 vs. −3.06 ± 4.08 kg/m 2 , P = 0.012) than Phentermine. Lorcaserin exhibited significant total cholesterol and LDL improvements only among surgical patients with significant weight reduction (≥5% TW). Both medications were not associated with glycemic improvements among non-surgical and surgical groups. Phentermine had slightly more side effects but was less expensive. Conclusions Among both patient groups, phentermine was more effective in achieving weight loss. Lorcaserin showed dyslipidemia improvements only among surgical patients who achieved significant weight reduction. Anti-obesity medications as part of weight management programs can result in weight loss among non-surgical and surgical patients, or halt weight regain among surgical patients. This is the first study to evaluate the effectiveness and safety of two anti-obesity medications (lorcaserin vs. phentermine) among two distinct obese patient groups, non-surgical and surgical patients.

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

“…Furthermore, these patients likely represent a distinct group of individuals with different background characteristics compared with the general obesity population. The RWE studies identified in this review indicate that AOMs may be a viable adjunctive treatment option for certain postsurgical patients 19,20,49,51–53 . Findings from real‐world practice also suggest that AOMs could have varying effects depending on type of metabolic surgery, 19,20,50 which may be due to the interplay between different surgical procedures and drug mechanism of action.…”

“… 19,20,49–53 Weight loss was experienced across studies regardless of patient population (e.g., T2DM or young adults 51,53 ) or surgery type. Furthermore, in one study, there was no apparent difference in percentage total weight loss with phentermine between surgical and non‐surgical patients, and in another study, no difference was observed between surgical and non‐surgical cohorts treated with liraglutide with respect to weight loss from baseline prior to drug initiation 19,49 . Significantly greater weight reductions were, however, reported in a Canadian prospective cohort study among liraglutide‐treated patients who had undergone RYGB compared with SG (Table 3).…”

“…A range of different AEs was reported in phentermine‐treated patients, with palpitations, dry mouth, insomnia, constipation, fatigue, and dizziness being among the most common 15,36,41,49 . Cardiovascular (CV) and cerebrovascular events were specifically evaluated in four studies.…”

“…were identified as including limited data on economic outcomes 16,49 or patient-reported outcomes. 17,18 This is also expected since routine real-world data sources like EMR or claims databases will often not capture patient-reported outcomes.…”

The Obese Brain: Mechanisms of Systemic and Local Inflammation, and Interventions to Reverse the Cognitive Deficit

“…Lorcaserin treatment showed a significant decrease in total cholesterol and low density lipoprotein (LDL) only among surgical patients with a significant weight reduction (≥5% total weight). Both drugs were not associated with glycemic improvements, and no differences were observed between the surgical and non-surgical groups ( Elhag et al, 2019 ).…”