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Long-term pharmacotherapy for overweight and obesity: a systematic review and meta-analysis of randomized controlled trials.
Int J Obes Relat Metab Disord. 2003 Dec; 27(12):1437-46.IJ

Abstract

CONTEXT

Safe and effective strategies to curb rising obesity prevalence rates are urgently needed and medications may play a more prominent role in future therapeutic regimens.

OBJECTIVE

To review systematically the long-term efficacy and safety of approved antiobesity medications.

DATA SOURCES

MEDLINE, EMBASE, the Cochrane Controlled Trials Register, Current Science Meta-register of Controlled Trials, and reference lists of original studies and reviews were searched. Drug manufacturers and two obesity experts were contacted. No language restrictions were imposed.

STUDY SELECTION

Double-blind, randomized controlled studies of approved antiobesity medications with follow-up periods of 1 y or greater were eligible for inclusion.

DATA EXTRACTION

Two reviewers independently assessed all potentially relevant studies for inclusion and methodological quality using standardized abstraction forms.

RESULTS

A total of 11orlistat (n=6021) and three sibutramine (n=929) studies met inclusion criteria. Attrition rates averaged 33% in orlistat studies and 48% in sibutramine studies. A random effects model was used for meta-analysis. Compared to placebo, orlistat-treated patients displayed a 2.7 kg (95% CI: 2.3-3.1 kg) or 2.9% (95% CI: 2.3-3.4%) greater reduction in weight and patients on sibutramine displayed a 4.3 kg (95% CI: 3.6-4.9 kg) or 4.6% (95% CI: 3.8-5.4%) greater weight reduction after 1 y of follow-up. The number of patients achieving 10% or greater weight loss was 12% (95% CI: 8-16%) higher with orlistat and 15% (95% CI: 4-27%) higher with sibutramine compared to placebo. Orlistat caused gastrointestinal side effects and sibutramine increased blood pressure and pulse rate.

CONCLUSION

There is a relative paucity of long-term studies of antiobesity agents. In weight loss trials of 1-y duration, orlistat and sibutramine appear modestly effective in promoting weight loss. Longer, more methodologically rigorous studies that are powered to examine end points such as mortality and cardiovascular morbidity are required.

Authors+Show Affiliations

Division of Internal Medicine, University of Alberta Hospital, 2E3. Walter C Mackenzie Health Sciences Centre, Edmonton, AB, Canada. rpadwal@yahoo.comNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Meta-Analysis
Review
Systematic Review

Language

eng

PubMed ID

12975638

Citation

Padwal, R, et al. "Long-term Pharmacotherapy for Overweight and Obesity: a Systematic Review and Meta-analysis of Randomized Controlled Trials." International Journal of Obesity and Related Metabolic Disorders : Journal of the International Association for the Study of Obesity, vol. 27, no. 12, 2003, pp. 1437-46.
Padwal R, Li SK, Lau DC. Long-term pharmacotherapy for overweight and obesity: a systematic review and meta-analysis of randomized controlled trials. Int J Obes Relat Metab Disord. 2003;27(12):1437-46.
Padwal, R., Li, S. K., & Lau, D. C. (2003). Long-term pharmacotherapy for overweight and obesity: a systematic review and meta-analysis of randomized controlled trials. International Journal of Obesity and Related Metabolic Disorders : Journal of the International Association for the Study of Obesity, 27(12), 1437-46.
Padwal R, Li SK, Lau DC. Long-term Pharmacotherapy for Overweight and Obesity: a Systematic Review and Meta-analysis of Randomized Controlled Trials. Int J Obes Relat Metab Disord. 2003;27(12):1437-46. PubMed PMID: 12975638.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Long-term pharmacotherapy for overweight and obesity: a systematic review and meta-analysis of randomized controlled trials. AU - Padwal,R, AU - Li,S K, AU - Lau,D C W, PY - 2003/9/17/pubmed PY - 2004/1/22/medline PY - 2003/9/17/entrez SP - 1437 EP - 46 JF - International journal of obesity and related metabolic disorders : journal of the International Association for the Study of Obesity JO - Int. J. Obes. Relat. Metab. Disord. VL - 27 IS - 12 N2 - CONTEXT: Safe and effective strategies to curb rising obesity prevalence rates are urgently needed and medications may play a more prominent role in future therapeutic regimens. OBJECTIVE: To review systematically the long-term efficacy and safety of approved antiobesity medications. DATA SOURCES: MEDLINE, EMBASE, the Cochrane Controlled Trials Register, Current Science Meta-register of Controlled Trials, and reference lists of original studies and reviews were searched. Drug manufacturers and two obesity experts were contacted. No language restrictions were imposed. STUDY SELECTION: Double-blind, randomized controlled studies of approved antiobesity medications with follow-up periods of 1 y or greater were eligible for inclusion. DATA EXTRACTION: Two reviewers independently assessed all potentially relevant studies for inclusion and methodological quality using standardized abstraction forms. RESULTS: A total of 11orlistat (n=6021) and three sibutramine (n=929) studies met inclusion criteria. Attrition rates averaged 33% in orlistat studies and 48% in sibutramine studies. A random effects model was used for meta-analysis. Compared to placebo, orlistat-treated patients displayed a 2.7 kg (95% CI: 2.3-3.1 kg) or 2.9% (95% CI: 2.3-3.4%) greater reduction in weight and patients on sibutramine displayed a 4.3 kg (95% CI: 3.6-4.9 kg) or 4.6% (95% CI: 3.8-5.4%) greater weight reduction after 1 y of follow-up. The number of patients achieving 10% or greater weight loss was 12% (95% CI: 8-16%) higher with orlistat and 15% (95% CI: 4-27%) higher with sibutramine compared to placebo. Orlistat caused gastrointestinal side effects and sibutramine increased blood pressure and pulse rate. CONCLUSION: There is a relative paucity of long-term studies of antiobesity agents. In weight loss trials of 1-y duration, orlistat and sibutramine appear modestly effective in promoting weight loss. Longer, more methodologically rigorous studies that are powered to examine end points such as mortality and cardiovascular morbidity are required. UR - https://www.unboundmedicine.com/medline/citation/12975638/Long_term_pharmacotherapy_for_overweight_and_obesity:_a_systematic_review_and_meta_analysis_of_randomized_controlled_trials_ L2 - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&PAGE=linkout&SEARCH=12975638.ui DB - PRIME DP - Unbound Medicine ER -