Prescribing trends and clinical characteristics of patients starting antiobesity drugs in the United States

Abstract

Aim: To assess the trends in the prescribing of antiobesity medications and the characteristics of patients recently initiating antiobesity drugs. Materials and Methods:We conducted a population-based cohort study using claims data from commercial health insurances in the United States. Patients initiating an antiobesity drug between January 2004 and December 2018 were included. Trends in the utilization of antiobesity medications were plotted by year, as a proportion of any antiobesity treatment, and as initiation rates per 100 000. Descriptive statistics were used to summarize the characteristics of antiobesity initiators.Results: From 2004 to 2018, 626 216 patients started an antiobesity medication (two per 100 000). Phentermine was the most frequently prescribed (50% in 2018).In recent years (2015)(2016)(2017)(2018), among 227 692 patients who initiated an antiobesity drug, 51% started phentermine, 19% naltrexone-bupropion, and 13% liraglutide 3.0 mg. Compared to other agents, the use of liraglutide 3.0 mg increased between 2015 and 2018. The average age of initiators was 45 years, 81% of initiators were female, 32% had hypertension, 25% had dyslipidaemia, and 6% had type 2 diabetes. Time on treatment was generally short (mean 81 days). Conclusion:The overall use of antiobesity medications remained low over the past 15 years and phentermine was the preferred antiobesity agent. Although the use of potentially safer antiobesity agents, for example, liraglutide 3.0 mg, has increased in recent years, phentermine remained the most frequently prescribed agent among middle-aged adults with a moderate burden of comorbidities.

Effectiveness of semaglutide versus liraglutide for treating post‐metabolic and bariatric surgery weight recurrence

“…Higher quality data will hopefully increase prescription rates [24] and insurance coverage [18] for AOMs. Obesity is not widely treated as a chronic disease, as <2% of eligible people receive AOMs, and the mean AOM prescription duration is only 81 days, which is inadequate to see maximum treatment response [25]. Health care providers and the scientific community must normalize the treatment of obesity as a chronic disease and decrease the clinical inertia for recommending AOMs, regardless of MBS status.…”

The Role of Positron Emission Tomography in Bariatric Surgery Research: a Review

“…To date, there is inconclusive evidence, given the small sample sizes and limited numbers of studies, to determine the effects of bariatric surgery on striatal dopamine receptors and further studies are recommended. Given that phentermine and bupropion (naltrexone-bupropion combination therapy) are the two most popular obesity medications [89], understanding changes in the dopaminergic system after bariatric surgery may help determine additional therapy for surgical non-responders who may have begun significant weight regain.…”

“…The opioid system is implicated in controlling appetite for specific macronutrients and the stimulation of intake motivated by hedonics rather than by energy needs [95,96]. Contrave (naltrexone/bupropion) has demonstrated ~5% body weight reduction over 1 year in several trials [97], and within the last 5 years has grown to account for 20% of anti-obesity prescriptions [89]. In the same cohort that found no changes in dopamine receptors using [ 11 C]raclopride after surgery [87], subjects were also scanned with [ 11 C]carfentanil.…”

Multiorgan Failure After Phentermine Overdose

“…There is a paucity of literature on consequences of phentermine overdose. 1 We present a case of multiorgan failure secondary to phentermine self-overdose in an elderly male.…”

“…Phentermine is a centrally acting sympathomimetic amine that suppresses appetite and assists with short-term weight loss. 1 Phentermine has a high potential of misuse. Adverse effects of tachycardia, decreased visual acuity, nausea, sleeplessness, anxiety, psychosis, and manic-like episodes are linked with phentermine therapy.…”