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Meta-Analysis
. 2004;2003(3):CD004094.
doi: 10.1002/14651858.CD004094.pub2.

Long-term pharmacotherapy for obesity and overweight

R Padwal  1 , S K Li, D C W Lau
Affiliations
Meta-Analysis

Long-term pharmacotherapy for obesity and overweight

R Padwal et al. Cochrane Database Syst Rev. 2004.

Abstract

Background: Worldwide prevalence rates of obesity and overweight are rising and safe and effective treatment strategies are urgently needed. A number of anti-obesity agents have been studied in short-term clinical trials, but long-term efficacy and safety need to be established.

Objectives: To assess/compare the effects and safety of approved anti-obesity medications in clinical trials of at least one-year duration.

Search strategy: MEDLINE, EMBASE, the Cochrane Controlled Trials Register, the Current Science Meta-register of Controlled Trials, and reference lists of original studies and reviews were searched. Date of last search was December 2002. Drug manufacturers and two obesity experts were contacted in to detect unpublished trials. No language restrictions were imposed.

Selection criteria: Double-blind, randomised controlled weight loss and weight maintenance trials of approved anti-obesity agents that 1) enrolled adult overweight or obese patients, 2) included a placebo control group or compared two or more anti-obesity drugs 3) used an intention-to-treat analysis, and 4) had a minimum follow-up period of one year. Abstracts and pseudo-randomised trials were not included.

Data collection and analysis: Two reviewers independently assessed all potentially relevant citations for inclusion and methodological quality. The primary outcome measure was weight loss.

Main results: Of the eight anti-obesity agents investigated, only orlistat and sibutramine trials met inclusion criteria. Eleven orlistat weight loss studies (four of which reported a second year weight maintenance phase) and five sibutramine studies (three weight loss and two weight maintenance trials) were included. Attrition rates averaged 33% during the weight loss phase of orlistat trials and 43% in sibutramine studies. All patients received lifestyle modification as a co-intervention. Compared to placebo, orlistat-treated patients lost 2.7 kg (95% CI: 2.3 kg to 3.1 kg) or 2.9% (95% CI: 2.3 % to 3.4%) more weight and patients on sibutramine experienced 4.3 kg (95% CI: 3.6 kg to 4.9 kg) or 4.6% (95% CI: 3.8% to 5.4%) greater weight loss. The number of patients achieving ten percent or greater weight loss was 12% (95% CI: 8% to 16%) higher with orlistat and 15% (95% CI: 4% to 27%) higher with sibutramine therapy. Weight loss maintenance results were similar. Orlistat caused gastrointestinal side effects and sibutramine was associated with small increases in blood pressure and pulse rate.

Reviewers' conclusions: Studies evaluating the long-term efficacy of anti-obesity agents are limited to orlistat and sibutramine. Both drugs appear modestly effective in promoting weight loss; however, interpretation is limited by high attrition rates. Longer and more methodologically rigorous studies of anti-obesity drugs that are powered to examine endpoints such as mortality and cardiovascular morbidity are required to fully evaluate any potential benefit of such agents.

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Conflict of interest statement

R. Padwal: none known. D. Rucker: none known. S. Li: none known. C.Curioni: none known. D. Lau: David Lau owns common shares in GlaxoSmithKline and Eli Lilly. He is a consultant to Abbott Laboratories, Ltd., AstraZeneca Canada Inc., Merck Frosst Canada Inc., Bristol‐Myers Squibb Canada, Eli Lilly Canada Inc., Oryx Pharmaceuticals Inc., Pfizer Canada Inc., sanofi‐aventis Canada Inc., Servier Canada Inc. and Solvay Pharma Inc.; and has received speaker fees from Abbott Laboratories, Ltd., AstraZeneca Canada Inc., GlaxoSmithKline, Merck Frosst Canada Inc., Merck/Schering, Eli Lilly Canada Inc., sanofi‐aventis Canada Inc. and Novo Nordisk Canada Inc.; research grants from AstraZeneca Canada Inc., Bristol Myers Squibb, Dainippon Pharmaceuticals, GlaxoSmithKline, Pfizer Canada Inc., and Sanofi‐Aventis Canada Inc.; and travel assistance to attend international meetings from Abbott Laboratories, Ltd., AstraZeneca Canada Inc. and Sanofi‐Aventis Canada Inc.

Figures

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1
QUOROM statement. This QUOROM (quality of reporting of meta‐analyses) diagram reflects the updated search only (December 2002 to December 2006)
2
2
Orlistat funnel plot.
See this image and copyright information in PMC

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