Rise in antiobesity drug prescribing for children and adolescents in the UK: a population‐based study

Abstract

WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT • The antiobesity drugs sibutramine and orlistat are not licensed for use in children and adolescents in the UK or USA.• Clinical trials suggest antiobesity drugs are effective and well‐tolerated in obese adolescents. WHAT THIS STUDY ADDS • Prescribing of unlicensed antiobesity drugs in children and adolescents has increased significantly in the past 8 years.• Most prescribed antiobesity drugs in children and adolescents are rapidly discontinued before patients can see clinical benefit, suggesting they are poorly tolerated or poorly efficacious.AIMS The international childhood obesity epidemic has driven increased use of unlicensed antiobesity drugs, whose efficacy and safety are poorly studied in children and adolescents. We investigated the use of unlicensed antiobesity drugs (orlistat, sibutramine and rimonabant) in children and adolescents (0–18 years) in the UK.METHODS Population‐based prescribing data from the UK General Practice Research Database between 1 January 1999 and 31 December 2006.RESULTS A total of 452 subjects received 1334 prescriptions during the study period. The annual prevalence of antiobesity drug prescriptions rose significantly from 0.006 per 1000 [95% confidence interval (CI) 0.0007, 0.0113] in 1999 to 0.091 per 1000 (95% CI 0.07, 0.11) in 2006, a 15‐fold increase, with similar increases seen in both genders. The majority of prescriptions were made to those ≥14 years old, although 25 prescriptions were made for children <12 years old. Orlistat accounted for 78.4% of all prescriptions; only one patient was prescribed rimonabant. However, approximately 45% of the patients ceased orlistat and 25% ceased sibutramine after only 1 month. The estimated mean treatment durations for orlistat and sibutramine were 3 and 4 months, respectively.CONCLUSIONS Prescribing of unlicensed antiobesity drugs in children and adolescents has dramatically increased in the past 8 years. The majority are rapidly discontinued before patients can see weight benefit, suggesting they are poorly tolerated or poorly efficacious when used in the general population. Further research into the effectiveness and safety of antiobesity drugs in clinical populations of children and adolescents is needed.

Severe Obesity in Children and Adolescents: Identification, Associated Health Risks, and Treatment Approaches

“…Although the use of medications to treat pediatric obesity is becoming more common, 180 the number of options is limited, and their safety and efficacy remain uncertain. Many of the medications used to treat obesity in adults, including 2 medications recently approved by the Food and Drug Administration (FDA), lorcaserin (Belviq) and the combination of phentermine and topiramate (Qsymia), along with bupropion and naltrexone, have never been studied in children and adolescents (the latter 2 are not approved by the FDA for the treatment of obesity).…”

Ist eine Therapie der Adipositas im Kindes- und Jugendalter überhaupt möglich?

“…Allerdings sind die Verschreibungszahlen für Anti-Adipositas-Medikamente für Jugendliche in England in den vergangenen Jahren stark angestiegen [10]. Außerdem mag der Einsatz der Pharmakotherapie bei sehr stark adipö-sen Jugendlichen durchaus seinen Stellenwert haben [7,8,9].…”

“…Pharmakologische Therapieformen unter Einsatz von gewichtsreduzierenden Medikamenten, Appetitzüglern und Medikamenten, die die Nährstoffaufnahme und -absorption hemmen, sowie von Ernährungszusätzen und pflanzlichen Präparaten gelten derzeit als eher klinisch nicht indiziert. Allerdings gibt es hierzu unterschiedliche Sichtweisen, und es wird derzeit eine Reihe von klinischen Studien mit Anti-Adipositas-Medikamenten an adipösen Jugendlichen durchgeführt [6,7,8,9,10,11].Vor dem Hintergrund der vielfälti-gen Komorbidität und der Langzeitauswirkungen der Adipositas im Kindesund Jugendalter scheint es sinnvoll und notwendig, effektive und effiziente Therapieformen für die Erkrankung zu finden und breit anzuwenden: In einer Kohorte von 236.835 dänischen Schulkindern wurde der Effekt des Körpermas-se-Indexes (BMI) während der Kindheit auf die Entstehung der koronaren Herzerkrankung im Erwachsenenalter untersucht. Dabei wurde das Vorkommen kardiovaskulärer Erkrankungen über eine Verbindung zum dänischen nationalen Register für kardiovaskuläre Erkrankungen in einer zweiten Datenquelle gesichert.…”

“…Pharmakologische Therapieformen unter Einsatz von gewichtsreduzierenden Medikamenten, Appetitzüglern und Medikamenten, die die Nährstoffaufnahme und -absorption hemmen, sowie von Ernährungszusätzen und pflanzlichen Präparaten gelten derzeit als eher klinisch nicht indiziert. Allerdings gibt es hierzu unterschiedliche Sichtweisen, und es wird derzeit eine Reihe von klinischen Studien mit Anti-Adipositas-Medikamenten an adipösen Jugendlichen durchgeführt [6,7,8,9,10,11].…”

Editorial for BJCP Special Obesity Edition

“…Li and Cheung provide a detailed review here of currently available anti-obesity agents [11]. This review highlights the fact that although only modest weight-loss is achieved by these agents, such weight-loss is clinically significant with regards to relevant biochemical markers and hypertension.This review is complimented by the paper of current paediatric prescribing by Viner et al, which provides an insight into the challenging area of paediatric obesity management [12]. Both of these papers do outline the need for long-term studies investigating efficacy and safety of anti-obesity agents in most age ranges, as obesity does affect all ages.…”