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Meta-Analysis
. 2021 Jan 17;1(1):CD007654.
doi: 10.1002/14651858.CD007654.pub5.

Long-term effects of weight-reducing drugs in people with hypertension

Affiliations
Meta-Analysis

Long-term effects of weight-reducing drugs in people with hypertension

Andrea Siebenhofer et al. Cochrane Database Syst Rev. .

Abstract

Background: This is the third update of this review, first published in July 2009. All major guidelines on treatment of hypertension recommend weight loss; anti-obesity drugs may be able to help in this respect.

Objectives: Primary objectives: To assess the long-term effects of pharmacologically-induced reduction in body weight in adults with essential hypertension on all-cause mortality, cardiovascular morbidity, and adverse events (including total serious adverse events, withdrawal due to adverse events, and total non-serious adverse events).. Secondary objectives: To assess the long-term effects of pharmacologically-induced reduction in body weight in adults with essential hypertension on change from baseline in systolic and diastolic blood pressure, and on body weight reduction.

Search methods: For this updated review, the Cochrane Hypertension Information Specialist searched the following databases for randomised controlled trials up to March 2020: the Cochrane Hypertension Specialised Register, CENTRAL, MEDLINE (from 1946), Embase (from 1974), the World Health Organization International Clinical Trials Registry Platform, and ClinicalTrials.gov. The searches had no language restrictions. We contacted authors of relevant papers about further published and unpublished work.

Selection criteria: Randomised controlled trials of at least 24 weeks' duration in adults with hypertension that compared approved long-term weight-loss medications to placebo. DATA COLLECTION AND ANALYSIS: Two review authors independently selected studies, assessed risks of bias, and extracted data. Where appropriate and in the absence of significant heterogeneity between studies (P > 0.1), we pooled studies using a fixed-effect meta-analysis. When heterogeneity was present, we used the random-effects method and investigated the cause of the heterogeneity.

Main results: This third update of the review added one new trial, investigating the combination of naltrexone/bupropion versus placebo. Two medications, which were included in the previous versions of this review (rimonabant and sibutramine) are no longer considered relevant for this update, since their marketing approval was withdrawn in 2010 and 2009, respectively. The number of included studies in this review update is therefore six (12,724 participants in total): four RCTs comparing orlistat to placebo, involving a total of 3132 participants with high blood pressure and a mean age of 46 to 55 years; one trial comparing phentermine/topiramate to placebo, involving 1305 participants with high blood pressure and a mean age of 53 years; and one trial comparing naltrexone/bupropion to placebo, involving 8283 participants with hypertension and a mean age of 62 years. We judged the risks of bias to be unclear for the trials investigating orlistat or naltrexone/bupropion. and low for the trial investigating phentermine/topiramate. Only the study of naltrexone/bupropion included cardiovascular mortality and morbidity as predefined outcomes. There were no differences in the rates of all-cause or cardiovascular mortality, major cardiovascular events, or serious adverse events between naltrexone/bupropion and placebo. The incidence of overall adverse events was significantly higher in participants treated with naltrexone/bupropion. For orlistat, the incidence of gastrointestinal side effects was consistently higher compared to placebo. The most frequent side effects with phentermine/topiramate were dry mouth and paraesthesia. After six to 12 months, orlistat reduced systolic blood pressure compared to placebo by mean difference (MD) -2.6 mm Hg (95% confidence interval (CI) -3.8 to -1.4 mm Hg; 4 trials, 2058 participants) and diastolic blood pressure by MD -2.0 mm Hg (95% CI -2.7 to -1.2 mm Hg; 4 trials, 2058 participants). After 13 months of follow-up, phentermine/topiramate decreased systolic blood pressure compared to placebo by -2.0 to -4.2 mm Hg (1 trial, 1030 participants) (depending on drug dosage), and diastolic blood pressure by -1.3 to -1.9 mm Hg (1 trial, 1030 participants) (depending on drug dosage). There was no difference in the change in systolic or diastolic blood pressure between naltrexone/bupropion and placebo (1 trial, 8283 participants). We identified no relevant studies investigating liraglutide or lorcaserin in people with hypertension.

Authors' conclusions: In people with elevated blood pressure, orlistat, phentermine/topiramate and naltrexone/bupropion reduced body weight; the magnitude of the effect was greatest with phentermine/topiramate. In the same trials, orlistat and phentermine/topiramate, but not naltrexone/bupropion, reduced blood pressure. One RCT of naltrexone/bupropion versus placebo showed no differences in all-cause mortality or cardiovascular mortality or morbidity after two years. The European Medicines Agency refused marketing authorisation for phentermine/topiramate due to safety concerns, while for lorcaserin the application for European marketing authorisation was withdrawn due to a negative overall benefit/risk balance. In 2020 lorcaserin was also withdrawn from the US market. Two other medications (rimonabant and sibutramine) had already been withdrawn from the market in 2009 and 2010, respectively.

PubMed Disclaimer

Conflict of interest statement

Andrea Siebenhofer, Klaus Jeitler, and Karl Horvath were involved in the preparation of a report on the evaluation of the benefits and harms of non‐drug treatment strategies in people with essential hypertension: weight reduction for the Institute for Quality and Efficiency in Health Care (iqwig.de/).

Andrea Berghold: none known.

Sebastian Winterholer: none known.

Cornelia Krenn: none known.

Thomas Semlitsch: none known.

Figures

1
1
Study flow diagram.
2
2
Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
3
3
Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
4
4
Forest plot of comparison: 1 Orlistat versus placebo, outcome: 1.3 Change in body weight from baseline to endpoint (6 to 12 months follow‐up) [kg].
5
5
Forest plot of comparison: 1 Orlistat versus placebo, outcome: 1.4 Change in systolic blood pressure from baseline to endpoint (6 to 12 months follow‐up) [mm Hg].
6
6
Forest plot of comparison: 1 Orlistat versus placebo, outcome: 1.5 Change in diastolic blood pressure from baseline to endpoint (6 to 12 months follow‐up) [mm Hg].
1.1
1.1. Analysis
Comparison 1: Orlistat versus placebo, Outcome 1: Serious adverse events
1.2
1.2. Analysis
Comparison 1: Orlistat versus placebo, Outcome 2: All adverse events
1.3
1.3. Analysis
Comparison 1: Orlistat versus placebo, Outcome 3: Change in body weight from baseline to endpoint (6 to 12 months follow‐up)
1.4
1.4. Analysis
Comparison 1: Orlistat versus placebo, Outcome 4: Change in systolic blood pressure from baseline to endpoint (6 to 12 months follow‐up)
1.5
1.5. Analysis
Comparison 1: Orlistat versus placebo, Outcome 5: Change in diastolic blood pressure from baseline to endpoint (6 to 12 months follow‐up)
2.1
2.1. Analysis
Comparison 2: Phentermine/topiramate versus placebo, Outcome 1: All adverse events
2.2
2.2. Analysis
Comparison 2: Phentermine/topiramate versus placebo, Outcome 2: Serious adverse events
2.3
2.3. Analysis
Comparison 2: Phentermine/topiramate versus placebo, Outcome 3: Change in body weight from baseline to endpoint: Phen/Top low dose (13 months follow‐up)
2.4
2.4. Analysis
Comparison 2: Phentermine/topiramate versus placebo, Outcome 4: Change in body weight from baseline to endpoint: Phen/Top high dose (13 months follow‐up)
2.5
2.5. Analysis
Comparison 2: Phentermine/topiramate versus placebo, Outcome 5: Change in systolic blood pressure from baseline to endpoint: Phen/Top low dose (13 months follow‐up)
2.6
2.6. Analysis
Comparison 2: Phentermine/topiramate versus placebo, Outcome 6: Change in systolic blood pressure from baseline to endpoint: Phen/Top high dose (13 months follow‐up)
2.7
2.7. Analysis
Comparison 2: Phentermine/topiramate versus placebo, Outcome 7: Change in diastolic blood pressure from baseline to endpoint: Phen/Top low dose (13 months follow‐up)
2.8
2.8. Analysis
Comparison 2: Phentermine/topiramate versus placebo, Outcome 8: Change in diastolic blood pressure from baseline to endpoint: Phen/Top high dose (13 months follow‐up)
3.1
3.1. Analysis
Comparison 3: Naltrexone/bupropion versus placebo, Outcome 1: Total mortality
3.2
3.2. Analysis
Comparison 3: Naltrexone/bupropion versus placebo, Outcome 2: Cardiovascular morbidity
3.3
3.3. Analysis
Comparison 3: Naltrexone/bupropion versus placebo, Outcome 3: All adverse events
3.4
3.4. Analysis
Comparison 3: Naltrexone/bupropion versus placebo, Outcome 4: Serious adverse events
3.5
3.5. Analysis
Comparison 3: Naltrexone/bupropion versus placebo, Outcome 5: Change in body weight from baseline to endpoint (28 months follow‐up)
3.6
3.6. Analysis
Comparison 3: Naltrexone/bupropion versus placebo, Outcome 6: Change in systolic blood pressure from baseline to endpoint (28 months follow‐up)
3.7
3.7. Analysis
Comparison 3: Naltrexone/bupropion versus placebo, Outcome 7: Change in diastolic blood pressure from baseline to endpoint (28 months follow‐up)

Update of

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Fujioka 2000 {published data only}
    1. Fujioka K, Seaton TB, Rowe E, Jelinek CA, Raskin P, Lebovitz HE, et al. Weight loss with sibutramine improves glycaemic control and other metabolic parameters in obese patients with type 2 diabetes mellitus. Diabetes, Obesity & Metabolism 2000;2(3):175-87. - PubMed
Fujioka 2016 {published data only}
    1. Fujioka K, Plodkowski R, O'Neil PM, Gilder K, Walsh B, Greenway FL. The relationship between early weight loss and weight loss at 1 year with naltrexone er/bupropion er combination therapy. International Journal of oOesity 2016;40(9):1369-75. [PMID: ] - PubMed
Gadde 2017 {published data only}
    1. Gadde KM, Pritham Raj Y. Pharmacotherapy of obesity: clinical trials to clinical practice. Current Diabetes Reports 2017;17(5):34. [PMID: ] - PubMed
Garvey 2009 {published data only}
    1. Garvey WT, Troupin B, Peterson C, Najarian T, Tam P, Day W. Treatment with VI-0521 (phentermine and topiramate) leads to one year durable glycaemic benefit and weight loss in subjects with type 2 diabetes. Diabetologia 2009;52(S1):S77. [EMBASE: 70067664]
    1. Garvey WT, Troupin B, Tam P, Najarian T, Peterson C, Day WW. One-year treatment with VI-0521 in type 2 diabetes demonstrates continued glycemic improvement and weight loss. Diabetes 2009;58(Suppl. 1):A95. [EMBASE: 70136156]
Gentile 2005 {published data only}
    1. Gentile S, Guarina G, Padovano B, Buonocunto F, Gruppo Campano Obesita. Efficacy and safety of a short-time orlistat treatment in obese subjects [Efficacia e sicurezza di impiego di un trattamento a breve termine con orlistat in soggetti obesi]. Annali Italiani di Medicina Interna 2005;20(2):90-6. - PubMed
Ginsberg 2004 {published data only}
    1. Ginsberg DL. Add-on sibutramine for olanzapine-induced weight gain. Primary Psychiatry 2004;11(7):24.
Greenway 2009 {published data only}
    1. Greenway FL, Dunayevich E, Tollefson G, Erickson J, Guttadauria M, Fujioka K, et al. Comparison of combined bupropion and naltrexone therapy for obesity with monotherapy and placebo. Journal of Clinical Endocrinology and Metabolism 2009;94:4898-906. [EMBASE: 2010011828] - PubMed
Greenway 2016 {published data only}
    1. Greenway FL, Shanahan Wm Fain R, Ma T, Rubino D. Safety and tolerability review of lorcaserin in clinical trials. Clinical Obesity 2016;6(5):285-95. [PMID: ] - PubMed
Halpern 2002 {published data only}
    1. Halpern A, Leite CC, Herszkowicz N, Barbato A, Costa AP. Evaluation of efficacy, reliability, and tolerability of sibutramine in obese patients, with an echocardiographic study. Revista do Hospital das Clinicas; Faculdade de Medicina Da Universidade de Sao Paulo 2002;57(3):98-102. - PubMed
Halpern 2003 {published data only}
    1. Halpern A, Mancini MC, Suplicy H, Zanella MT, Repetto G, Gross J, et al. Latin-American trial of orlistat for weight loss and improvement in glycaemic profile in obese diabetic patients. Diabetes, Obesity & Metabolism 2003;5(3):180-8. - PubMed
Halseth 2018 {published data only}
    1. Acevedo LM, Shan K, Fujioka K. Improvement in patient-assessed quality of life, eating behavior, and sexual function after 26 weeks of naltrexone/ bupropion compared with usual care. Obesity Facts 2016;9(Suppl 1):177. [EMBASE: 72315993]
    1. Fujioka, K, Walsh B, Halseth AE, Shan K, Wadden TA. Improvement in patient-assessed quality of life, eating behavior, and sexual function after 26 weeks of naltrexone/bupropion compared with usual care. Diabetes 2015;64(Suppl 1):A308. [EMBASE: 71940993]
    1. Halseth A, Shan K, Chen S. Long-term efficacy of naltrexone/bupropion, administered as recommended in clinical practice. Obesity Facts 2016;9(Suppl 1):178. [EMBASE: 72315729]
    1. Halseth A, Shan K, Fujioka K. Efficacy of naltrexone/bupropion, administered asS recommended in clinical practice, compared with usual care for weight management. Obesity Facts 2016;9(Suppl 1):80-1. [EMBASE: 72315729]
    1. Halseth A, Shan K, Gilder K, Malone M, Acevedo L, Fujioka K. Quality of life, binge eating and sexual function in participants treated for obesity with sustained release naltrexone/bupropion. Obesity Science and Practice 2018;4(2):141-52. [PMID: ] - PMC - PubMed
Hauner 2004 {published data only}
    1. Hauner H, Meier M, Wendland G, Kurscheid T, Lauterbach K, The SAT Study Group. Weight reduction by sibutramine in obese subjects in primary care medicine: the SAT Study. Experimental and Clinical Endocrinology & Diabetes 2004;112(4):201-7. - PubMed
Hauptman 2000 {published data only}
    1. Hauptman J, Lucas C, Boldrin MN, Collins H, Segal KR. Orlistat in the long-term treatment of obesity in primary care settings. Archives of Family Medicine 2000;9(2):160-7. - PubMed
Heinonen 2009 {published data only}
    1. Heinonen MV, Laaksonen DE, Karhu T, Karhunen L, Laitinen T, Kainulainen S, et al. Effect of diet-induced weight loss on plasma apelin and cytokine levels in individuals with the metabolic syndrome. Nutrition, Metabolism and Cardiovascular Diseases 2009;19(9):626-33. - PubMed
Hollander 2007 {published data only}
    1. Hollander P. Endocannabinoid blockade for improving glycemic control and lipids in patients with type 2 diabetes mellitus. American Journal of Medicine 2007;120(2 Suppl 1):S18-28. - PubMed
Hung 2005 {published data only}
    1. Hung YJ, Chen YC, Pei D, Kuo SW, Hsieh CH, Wu LY, et al. Sibutramine improves insulin sensitivity without alteration of serum adiponectin in obese subjects with Type 2 diabetes. Diabetic Medicine 2005;22(8):1024-30. - PubMed
Jain 2011 {published data only}
    1. Jain SS, Ramanand SJ, Ramanand JB, Akat PB, Patwardhan MH, Joshi SR. Evaluation of efficacy and safety of orlistat in obese patients. Indian Journal of Endocrinology and Metabolism 2011;15(2):99-104. - PMC - PubMed
James 1997 {published data only}
    1. James WP, Avenell A, Broom J, Whitehead J. A one-year trial to assess the value of orlistat in the management of obesity. International Journal of Obesity & Related Metabolic Disorders: Journal of the International Association for the Study of Obesity 1997;21 Suppl 3:S24-30. - PubMed
James 2000 {published data only}
    1. James WP, Astrup A, Finer N, Hilsted J, Kopelman P, Rossner S, et al. Effect of sibutramine on weight maintenance after weight loss: a randomised trial. STORM Study Group. Sibutramine Trial of Obesity Reduction and Maintenance [see comment]. Lancet 2000;356(9248):2119-25. - PubMed
Jia 2010 {published data only}
    1. Jia J, Xiong L, Chen S. Trial of lorcaserin for weight management. New England Journal of Medicine 2010;363(25):2468-9. [PMID: ] - PubMed
Jordan 2012 {published data only}
    1. Jordan J, Astrup AV, Day WW. Effects of phentermine and extended-release topiramate alone and in combination on cardiovascular risk factors. Diabetologia 2012;55:S285. [EMBASE: 70888718]
Kaukua 2004 {published data only}
    1. Kaukua JK, Pekkarinen TA, Rissanen AM. Health-related quality of life in a randomised placebo-controlled trial of sibutramine in obese patients with type II diabetes. International Journal of Obesity & Related Metabolic Disorders: Journal of the International Association for the Study of Obesity 2004;28(4):600-5. - PubMed
KCT0002097 {published data only}
    1. KCT0002097. A 48 weeks, double-blind, randomized, placebo-controlled clinical trial for the evaluation of the efficacy and safety of obesity medication on morbid obese and obese patients. www.who.int/trialsearch/Trial2.aspx?TrialID=KCT0002097 (first received 07 October 2016).
Kelley 2002 {published data only}
    1. Kelley DE, Bray GA, Pi-Sunyer FX, Klein S, Hill J, Miles J, et al. Clinical efficacy of orlistat therapy in overweight and obese patients with insulin-treated type 2 diabetes: a 1-year randomized controlled trial [erratum appears in Diabetes Care 2003 Mar;26(3):971]. Diabetes Care 2002;25(6):1033-41. - PubMed
Kern 2017 {published data only}
    1. Kern W. Obesity and weight reduction: current findings on liraglutid 3.0 mg [Gewichtsreduktion bei Adipositas: Aktueller Erkenntnisstand zu Liraglutid 3,0 mg]. Diabetes, Stoffwechsel und Herz 2017;26(2):75-83.
Kim 2016 {published data only}
    1. Kim S. Drugs to treat obesity: do they work? Postgraduate Medical Journal 2016;92(1089):401-6. [PMID: ] - PubMed
Klassen 2016 {published data only}
    1. Klassen P, Halseth A, Chilton R. Weight loss, blood pressure, pulse, and circadian patterns with prolonged-release naltrexone /bupropion combination therapy for obesity. Obesity Facts 2016;9:245. [EMBASE: 4300320]
    1. Klassen P, Halseth AE, Chilton R. Weight loss, blood pressure, pulse, and circadian patterns with combination prolonged-release naltrexone/bupropion therapy for obesity. Obesity Reviews 2016;17(Supplement 2):69. [EMBASE: 7455004]
LEADER 2013 {published data only}
    1. Bain SC, Petrie J. Liraglutide effect and action in diabetes: evaluation of cardiovascular outcome results (LEADER™) trial: rationale and study design. Diabetic Medicine 2012;29:68. [EMBASE: 70695949]
    1. Bergenstal R, Daniels G, Mann J, Nissen S, Pocock S, Zinman B, et al. Liraglutide effect and action in diabetes: Evaluation of cardiovascular outcome results (LEADER™) trial: Rationale and study design. Diabetes 2011;60:A612-3. [EMBASE: 70630008]
    1. Consoli A, Bergenstal R, Daniels G, Mann J, Nissen S, Pocock S, et al. Liraglutide effect and action in diabetes: Evaluation of cardiovascular outcome results (leader) trial: Rationale and study design. High Blood Pressure and Cardiovascular Prevention 2012;19(2):104. [EMBASE: 713987964]
    1. Mannucci E, Bergenstal R, Daniels G, Mann J, Nissen S, Zinman B, et al. Liraglutide Effect and Action in Diabetes: Evaluation of cardiovascular outcome Results (LEADER) Trial: Rationale and study design. Italian Journal of Medicine 2012;6(1 Suppl 1):86. [EMBASE: 70799751]
    1. Marso SP, Poulter NR, Nissen SE, Nauck MA, Zinman B, Daniels GH, et al. Design of the liraglutide effect and action in diabetes: Evaluation of cardiovascular outcome results (LEADER) trial. American Heart Journal 2013;166:823-30. [EMBASE: 2013691152] - PubMed
Le Roux 2018 {published data only}
    1. Le Roux C, Aroda V, Hemmingsson J, Cancino AP, Christensen R, Pi-Sunyer X. Comparison of efficacy and safety of liraglutide 3.0 mg in Individuals with BMI above and below 35 kg/m2: a post-hoc analysis. Obesity Facts 2018;10(6):531-44. [PMID: ] - PMC - PubMed
Lewis 2014 {published data only}
    1. Lewis K. Weight loss achieved with medication can delay onset of type 2 diabetes in at-risk individuals. Journal of Clinical Outcomes Management 2014;21:393-5. [EMBASE: 2014910274]
Lindgarde 2000 {published data only}
    1. Lindgarde F. The effect of orlistat on body weight and coronary heart disease risk profile in obese patients: the Swedish Multimorbidity Study [see comment]. Journal of Internal Medicine 2000;248(3):245-54. - PubMed
Lindgarde 2001a {published data only}
    1. Lindgarde F. Orlistat with diet was effective and safe for weight loss and coronary risk reduction in obesity. Evidence-based Medicine 2001;6(2):54.
Lindgarde 2001b {published data only}
    1. Lindgarde F. Effect of orlistat on coronary heart disease risk in obese patients with hypertension and/or hyperlipidemia. American Heart Journal 2001;141(1):171.
Lu 2018 {published data only}
    1. Lu CW, Chang CJ, Yang YC, Lin WY, Huang KC. Multicentre, placebo-controlled trial of lorcaserin for weight management in Chinese population. Obesity Research & Clinical Practice 2018;12(5):465-71. [PMID: ] - PubMed
Madsen 2009 {published data only}
    1. Madsen EL, Bruun JM, Skogstrand K, Hougaard DM, Christiansen T, Richelsen B. Long-term weight loss decreases the nontraditional cardiovascular risk factors interleukin-18 and matrix metalloproteinase-9 in obese subjects. Metabolism 2009;58(7):946-53. - PubMed
McMahon 2000 {published data only}
    1. McMahon FG, Fujioka K, Singh BN, Mendel CM, Rowe E, Rolston K, et al. Efficacy and safety of sibutramine in obese white and African American patients with hypertension: a 1-year, double-blind, placebo-controlled, multicenter trial. Archives of Internal Medicine 2000;160(14):2185-91. [PMID: ] - PubMed
McMahon 2002 {published data only}
    1. McMahon FG, Weinstein SP, Rowe E, Ernst KR, Johnson F, Fujioka K, et al. Sibutramine is safe and effective for weight loss in obese patients whose hypertension is well controlled with angiotensin-converting enzyme inhibitors. Journal of Human Hypertension 2002;16(1):5-11. [PMID: ] - PubMed
McNulty 2003 {published data only}
    1. McNulty SJ, Ur E, Williams G, Multicenter Sibutramine Study Group. A randomized trial of sibutramine in the management of obese type 2 diabetic patients treated with metformin. Diabetes Care 2003;26(1):125-31. - PubMed
Miles 2002 {published data only}
    1. Miles JM, Leiter L, Hollander P, Wadden T, Anderson JW, Doyle M, et al. Effect of orlistat in overweight and obese patients with type 2 diabetes treated with metformin [erratum appears in Diabetes Care 2002 Sep;25(9):1671]. Diabetes Care 2002;25(7):1123-8. - PubMed
Moore 2016 {published data only}
    1. Moore KG, Shealy K, Clements JN. Liraglutide, GLP-1 receptor agonist, for chronic weight loss. Expert Review of Endocrinology & Metabolism 2016;11(5):373-8. [PMID: ] - PubMed
NCT01764386 {published data only}
    1. NCT01764386. A multicenter, randomized, open-label, controlled, method-of-use study assessing the effect of naltrexone sustained release (SR)/bupropion SR on body weight and cardiovascular risk factors in overweight and obese subjects (The Ignite Study). clinicaltrials.gov/ct2/show/NCT01764386 (first received 09 January 2013).
Niskanen 2010 {published data only}
    1. Niskanen L, Astrup A, Hakim MA, Carraro R, Finer N, Hartvig H, et al. Liraglutide once daily reduces the prevalence of prediabetes and metabolic syndrome in obese non-diabetic adults: a 2-year randomized trial. Obesity 2010;18:S56. [EMBASE: 71774529]
Nissen 2008 {published data only}
    1. Nissen SE, Nicholls SJ, Wolski K, Rodes-Cabau J, Cannon CP, Deanfield JE, et al. Effect of rimonabant on progression of atherosclerosis in patients with abdominal obesity and coronary artery disease: the STRADIVARIUS randomized controlled trial. JAMA 2008;299(13):1547-60. - PubMed
O'Leary 2011 {published data only}
    1. O'Leary DH, Reuwer AQ, Nissen SE, Despres JP, Deanfield JE, Brown MW, et al. Effect of rimonabant on carotid intima-media thickness (CIMT) progression in patients with abdominal obesity and metabolic syndrome: the AUDITOR Trial. Heart 2011;97(14):1143-50. - PubMed
Pathan 2004 {published data only}
    1. Pathan MF, Latif ZA, Nazneen NE, Mili SU. Orlistat as an adjunct therapy in type 2 obese diabetic patients treated with sulphonylurea: a Bangladesh experience. Bangladesh Medical Research Council Bulletin 2004;30(1):1-8. - PubMed
Patschan 2007 {published data only}
    1. Patschan S, Scholze J. Obesity-related hypertension. Cardiology Review 2007;24(12):32-5.
Pi‐Sunyer 2006 {published data only}
    1. Pi-Sunyer FX, Aronne LJ, Heshmati HM, Devin J, Rosenstock J, RIO-North America Study Group. Effect of rimonabant, a cannabinoid-1 receptor blocker, on weight and cardiometabolic risk factors in overweight or obese patients: RIO-North America: a randomized controlled trial [see comment] [erratum appears in JAMA 2006 Mar 15;295(11):1252]. JAMA 2006;295(7):761-75. - PubMed
Reaven 2001 {published data only}
    1. Reaven G, Segal K, Hauptman J, Boldrin M, Lucas C. Effect of orlistat-assisted weight loss in decreasing coronary heart disease risk in patients with syndrome X. American Journal of Cardiology 2001;87(7):827-31. - PubMed
Rossner 2000 {published data only}
    1. Rossner S, Sjöström L, Noack R, Meinders AE, Noseda G. Weight loss, weight maintenance, and improved cardiovascular risk factors after 2 years treatment with orlistat for obesity. European Orlistat Obesity Study Group. Obesity Research 2000;8(1):49-61. - PubMed
Rossner 2001 {published data only}
    1. Rossner S. Sibutramine - antidepressive agent tested against obesity [Sibutramin – antidepressivt läkemedel prövat mot fetma]. Lakartidningen 2001;98(15):1802-3. - PubMed
Samuelsson 2003 {published data only}
    1. Samuelsson L, Gottsater A, Lindgarde F. Decreasing levels of tumour necrosis factor alpha and interleukin 6 during lowering of body mass index with orlistat or placebo in obese subjects with cardiovascular risk factors. Diabetes, Obesity and Metabolism 2003;5(3):195-201. - PubMed
SCALE diabetes 2014 {published data only}
    1. Bode B, DeFronzo R, Bergenstal R, Kushner R, Lewin A, Skjoth TV, et al. Effect of liraglutide 3.0/1.8 mg on body weight and cardiometabolic risk factors in overweight/obese adults with type 2 diabetes: SCALE diabetes randomised, double-blind, 56-week trial. Diabetologia 2014;57(Suppl 1):S83. [EMBASE: 71594831]
    1. Davies MJ, DeFronzo RA, Bergenstal RM, Bode BW, Kushner R, Noctor M, et al. Liraglutide 3.0mg results in significant weight loss and improvements in cardiometabolic risk factors compared with liraglutide 1.8mg or placebo: a randomised, double-blind, 56 week trial in overweight/obese adults with Type 2 diabetes (SCALE diabetes). Diabetic Medicine 2015;32:72. [EMBASE: 71821008]
    1. DeFronzo RA, Bergenstal RM, Bode B, Kushner R, Lewin AJ, Skjoth TV, et al. Effects of liraglutide 3.0 mg and 1.8 mg on body weight and cardiometabolic risk factors in overweight and obese adults with type 2 diabetes mellitus (T2DM): the SCALE diabetes randomized, double-blind, placebo-controlled, 56-week trial. Endocrine Reviews 2014;35:var. [EMBASE: 4344566]
    1. Pedersen S, Defronzo RA, Bergenstal R, Bode B, Kushner R, Lewin A, et al. Effects of liraglutide 3.0 mg and 1.8 mg on body weight and cardiometabolic risk factors in adults with overweight or obesity and type 2 diabetes (T2D): The SCALE diabetes randomized, double-blind, placebo-controlled, 56-week trial. Canadian Journal of Diabetes 2015;39:S36. [EMBASE: 1860363]
SCALE maintenance 2013 {published data only}
    1. Hollander P, Aronne L, Klein S, Niswender K, Jensen CB, Woo V, et al. Diet-induced weight loss and subsequent addition of liraglutide 3.0 mg reduces impaired fasting glucose in overweight/obese adults in the SCALE™ maintenance 56-week randomised trial. Journal of Diabetes 2013;5:124. [EMBASE: 71034943]
    1. Klein S, Aronne LJ, Hollander P, Niswender K, Woo V, Hale PM, et al. Effect of liraglutide on cardiovascular (CV) risk factors in adults without diabetes after diet-induced weight loss: the SCALE 56-week randomized study. Obesity 2011;19:S177.
SCALE obesity and prediabetes 2014 {published data only}
    1. Astrup A, Fujioka K, Violante Ortiz R, Jensen CB, Lillerre SK, O'Neil P. Efficacy and safety of liraglutide 3.0 mg in adult overweight and obese weight loss responders without diabetes: results of the 56-week randomised, controlled, SCALE Obesity and Prediabetes trial. Obesity Facts 2015;8(Suppl 1):42. [EMBASE: 71907401]
    1. Astrup A, Greenway F, Krempf M, Le Roux CW, Vettor R, Shapiro Manning L, et al. Weight loss and associated improvements in cardiometabolic risk factors with liraglutide 3.0 mg in the SCALE Obesity and Prediabetes randomised, double-blind, placebo-controlled 3-year trial. Obesity Facts 2016;9(Suppl 1):182. [EMBASE: 72316004]
    1. Bjorner JB, Brett JH, Meincke HH, Kolotkin RL. The effect of liraglutide 3.0 mg for weight management on hrqol, as measured by SF-36: 3-year data. Diabetologia 2016;59(1 Suppl 1):S330. [EMBASE: 612314178]
    1. Fujioka K, Greenway FL, Krempf M, Le Roux CW, Vettor R, Manning LS, et al. Liraglutide 3.0 mg reduces body weight and improves cardiometabolic risk factors in adults with obesity or overweight and prediabetes: the SCALE Obesity and Prediabetes randomized, double-blind, placebo-controlled 3-year trial. Endocrine Reviews 2016;37(2 Suppl 1):no pagination. [EMBASE: 613520086]
    1. Fujioka K, Wilding JP, Astrup A, Greenway F, Halpern A, Krempf M, et al. Efficacy and safety of liraglutide 3.0 mg for weight management in overweight/obese adults: The SCALE Obesity and Prediabetes trial. Diabetologia 2014;57(Suppl1):S368-9. [EMBASE: 71595554]
SCALE sleep apnoea 2014 {published data only}
    1. Blackman A, Foster G, Zammit G, Rosenberg R, Aronne L, Wadden T, et al. Liraglutide 3.0 mg reduces severity of obstructive sleep apnea and body weight in obese individuals with moderate or severe disease: SCALE sleep apnoea tria. Sleep Medicine 2015;16(Suppl 1):S24. [EMBASE: 4282911]
    1. Blackman A, Foster G, Zammit G, Rosenberg R, Aronne L, Wadden T, et al. Liraglutide 3.0 mg reduces severity of obstructive sleep apnoea and body weight in obese individuals with moderate or severe disease: SCALE sleep apnoea trial. Diabetologia 2014;57(1 Suppl 1):S85. [EMBASE: 1745360]
    1. Blackman A, Foster G, Zammit G, Rosenberg R, Wadden T, Aronne L, et al. Liraglutide 3.0 mg reduces severity of obstructive sleep apnea and body weight in individuals with obesity and moderate or severe disease: SCALE sleep apnoea trial. Canadian Journal of Diabetes 2015;39(Suppl 1):S35. [EMBASE: 1826652]
    1. Blackman A, Foster GD, Zammit G, Rosenberg R, Aronne L, Wadden T, et al. Effect of liraglutide 3.0mg in individuals with obesity and moderate or severe obstructive sleep apnea: the SCALE sleep apnea randomized clinical trial. International Journal of Obesity 2016;40(8):1310-9. [PMID: ] - PMC - PubMed
    1. Collier A, Blackman A, Foster G, Zammit G, Rosenberg R, Wadden T, et al. Liraglutide 3.0 mg reduces severity of obstructive sleep apnoea and body weight in obese individuals with moderate or severe disease: SCALE sleep apnoea trial. Thorax 2014;69(Suppl 2):A16-7. [EMBASE: 71688686]
Scheen 2002 {published data only}
    1. Scheen AJ, Ernest P. New antiobesity agents in type 2 diabetes: Overview of clinical trials with sibutramine and orlistat. Diabetes and Metabolism 2002;28(6 I):437-45. - PubMed
Scott 2015 {published data only}
    1. Scott LJ. Liraglutide: a review of its use in the management of obesity. Drugs 2015;75(8):899-910. [PMID: ] - PubMed
SCOUT 2010 {published data only}
    1. James P, Caterson I, Coutinho W, Finer N, Van Gaal L, Maggioni A, et al. Effects on mortality and morbidity in overweight/obese subjects: the sibutramine cardiovascular outcomes (SCOUT) trial. Journal of the American College of Cardiology 2010;Conference: American College of Cardiology's 59th Annual Scientific Session and i2 Summit: Innovation in Intervention Atlanta, GA United States. Conference Start: 20100314 Conference End: 20100316. Conference Publication:(var.pagings). 55 (10 SUPPL 1):A141.E1326.
    1. James WP, Caterson ID, Coutinho W, Finer N, Van Gaal LF, Maggioni AP, et al. Effect of sibutramine on cardiovascular outcomes in overweight and obese subjects. New England Journal of Medicine 2010;363(10):905-17. - PubMed
    1. Kamil S, Finer N, James WP, Caterson ID, Andersson C, Torp-Pedersen C. Influence of sibutramine in addition to diet and exercise on the relationship between weight loss and blood glucose changes. European Heart Journal - Cardiovascular Pharmacotherapy 2017;3(3):134-9. [PMID: ] - PubMed
    1. Maggioni AP, Caterson I, Coutinho W, Finer N, Gaal LV, Sharma AM, et al. Tolerability of sibutramine during a 6-week treatment period in high-risk patients with cardiovascular disease and/or diabetes: a preliminary analysis of the Sibutramine Cardiovascular Outcomes (SCOUT) Trial. Journal of Cardiovascular Pharmacology 2008;52(5):393-402. - PubMed
    1. Seimon R, Espinoza D, Ivers L, Gebski V, Finer N, Legler U, et al. Changes in body weight and blood pressure: Paradoxical outcome events in overweight and obese subjects with cardiovascular disease. Obesity Reviews 2014;15:173. [EMBASE: 71516191] - PubMed
SEQUEL 2014 {published data only}
    1. Garvey WT, Najarian T, Peterson CA. Significant weight loss with controlled-release phentermine/topiramate (PHEN/TPM CR) is associated with significant reductions in use of concomitant medications for cardiometabolic diseases over 108 weeks. Obesity 2011;19:S176. [EMBASE: 70680319]
    1. Garvey WT, Ryan DH, Henry R, Bohannon NJ, Toplak H, Schwiers M, et al. Prevention of type 2 diabetes in subjects with prediabetes and metabolic syndrome treated with phentermine and topiramate extended release. Diabetes Care 2014;37:912-21. [PMID: ] - PMC - PubMed
    1. Garvey WT, Ryan DH, Look M, Gadde KM, Allison DB, Peterson CA, et al. Two-year sustained weight loss and metabolic benefits with controlled-release phentermine/topiramate in obese and overweight adults (SEQUEL): a randomized, placebo-controlled, phase 3 extension study. American Journal of Clinical Nutrition 2012;95:297-308. [EMBASE: 2012064424] - PMC - PubMed
    1. Klein S, Najarian T, Troupin B, Day WW. Weight loss (WL) with low-dose, controlled-release phentermine/topiramate (PHEN/TPM CR) correlates with improvements in liver function in overweight/obese adults with elevated alanine aminotransferase (ALT). Obesity 2011;19:S177. [EMBASE: 70680321]
    1. Toplak H, Rossner S, Garvey WT, Troupin B, Bowden CH. Long-term weight loss with controlled-release phentermine/topiramate reverses metabolic syndrome and improves associated traits. Diabetologia 2011;54:S370. [EMBASE: 70563050]
Sharif 2016 {published data only}
    1. Sharif Z, Peikanpour M, Rangchian M, Foroughi Moghadam MJ. Cost-utility analysis of lorcaserin in the treatment of obesity. Value in Health 2017;7:A590-A591. [EMBASE: 613234809]
Shaw Tronieri 2018 {published data only}
    1. Shaw Tronieri J, Wadden TA, Berkowitz RI, Chao AM, Pearl RL, Alamuddin N, et al. A randomized trial of lorcaserin and lifestyle counseling for maintaining weight loss achieved with a low-calorie diet. Obesity 2018;26(2):299-309. [PMID: ] - PubMed
Sjöström 1998 {published data only}
    1. Sjöström L, Rissanen A, Andersen T, Boldrin M, Golay A, Koppeschaar HP, et al. Randomised placebo-controlled trial of orlistat for weight loss and prevention of weight regain in obese patients. European Multicentre Orlistat Study Group [see comment]. Lancet 1998;352(9123):167-72. - PubMed
Starling 2001 {published data only}
    1. Starling RD, Liu X, Sullivan DH. Influence of sibutramine on energy expenditure in African American women. Obesity Research 2001;9(4):251-6. [PMID: ] - PubMed
Strebkova 2015 {published data only}
    1. Strebkova E, Solovyova I, Sharapova E, Mkrtumyan A, Alekseeva L, Nasonov E. Impact of body weight loss on the clinical manifestations of knee osteoarthritis and metabolic syndrome parameters in female patients with obesity taking orlistat. Annals of the Rheumatic Diseases 2015;74:1183-4. [EMBASE: 4338732]
Suyog 2011 {published data only}
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References to other published versions of this review

Siebenhofer 2009
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Siebenhofer 2009a
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Siebenhofer 2013
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