Pharmacotherapy for Children and adolescents with overweight and obesity: a systematic review and network meta-analysis of randomized controlled trials

Abstract

Background: Overweight and obesity are widespread among children and adolescents. We aimed to summarize the evidence for the pharmacotherapy as an adjunct to lifestyle interventions in overweight or obese children and adolescents by comparing the benefits and harms. Methods: RCTs (randomized controlled trials) were sourced from PubMed, Embase (using the OVID platform), the Cochrane Library (CENTRAL), as well as the trial registers ICTRP (WHO) and ClinicalTrials.gov. Searches were undertaken from inception to April 25, 2023. A network meta-analysis was performed using the frequentists framework based on random-effects model. We used GRADE (Grading of Recommendations Assessment, Development, and Evaluation) approach to evaluate the overall certainty of evidence and categorized the interventions. Results: In total, 42 RCTs (n=3883) comparing 8 different pharmacotherapy strategies were included in this study. Evidence strongly suggested that phentermine-topiramate reduced BMI the most (the mean difference (MD) -4.83 [95% CI, -7.46 to -2.20] kg/m2) and weight (MD, -14.59 [95% CI, -19.37, -9.81] kg) in children and adolescents with overweight or obesity. Compared to lifestyle intervention alone, phentermine-topiramate was associated with an additional 557 events per 1000 person-years in terms of the proportion of participants achieving a BMI reduction of ≥5%, but there was no increased harm in total gastrointestinal adverse effects and discontinuation due to adverse events. Conclusions: Phentermine-topiramate was closely related to weight loss and showed a good tolerability, proving to be the optimal treatment strategy for overweight or obese children and adolescents.