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FDA-approved weight loss drugs modestly improve cardiometabolic risk factors

17 Jan 2018

Weight loss medications that have received the Food and Drug Administration (FDA) approval appear to confer only modest positive benefits for cardiometabolic risk profile, according to a study.

Researchers conducted a systematic review and meta-analysis of randomized clinical trials investigating the effects of at least 1 year of treatment with FDA-approved weight loss medications (eg, orlistat, lorcaserin, naltrexone-bupropion, phentermine-topiramate and liraglutide) in obese adults as compared with placebo or another active agent.

Outcomes investigated were changes in blood glucose (fasting blood glucose [FBG] and haemoglobin A1c [A1c]), cholesterol profile (low-density lipoprotein and high-density lipoproteins [HDL]), blood pressure (BP; systolic/diastolic) and waist circumference (WC). Quality of evidence was evaluated using GRADE.

Pooled data from 28 trials, including 29,018 participants (median body mass index, 36.1 kg/m2), showed that weight loss medications were associated with a modest reduction in FBG (weighted mean difference [WMD], –4.0 mg/dL; 95 percent CI, –4.4 to –3.6) and in WC (WMD, –3.3 cm;–3.5 to –3.1). The drugs did not produce clinically meaningful changes in systolic/diastolic BP or cholesterol profile compared with placebo (standardized mean difference, <0.2), with the effects varying among drugs.

In particular, treatment with phentermine-topiramate resulted in a substantial reduction in WC, as well as a modest decrease in FBG, A1c and BP, with a minimal effect on cholesterol. Liraglutide use led to a substantial decrease in FBG, A1c and WC, with a minimal effect on BP and cholesterol. Naltrexone-bupropion use, on the other hand, was associated with moderate increase in HDL cholesterol with a minimal effect on FBG and WC. Finally, orlistat treatment delivered a reduction in low-density lipoprotein and HDL-cholesterol. None of these drugs produced improvements in all cardiometabolic risk factors.

Researchers called for additional studies to investigate the long-term cardiometabolic benefits of these weight loss medications. 

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