Long-term Drug Treatment for Obesity: A Systematic and Clinical Review. Yanovski, S. Z. & Yanovski, J. A. JAMA, 311(1):74, January, 2014. ![Long-term Drug Treatment for Obesity: A Systematic and Clinical Review [link]](https://bibbase.org/img/filetypes/link.svg "link")
Paper doi abstract bibtex Objective—Conduct a systematic review of medications currently approved in the US for obesity treatment in adults. We also discuss off-label use of medications studied for obesity and provide considerations for obesity medication use in clinical practice. Evidence Acquisition—A PubMed search from inception through September, 2013 was performed to find meta-analyses, systematic reviews, and randomized, placebo-controlled trials for currently-approved obesity medications lasting ≥1y, that had a primary or secondary outcome of body weight, included ≥50 participants per group, reported ≥50% retention, and reported results on an intention-to-treat basis. Studies of medications approved for other purposes but tested for obesity treatment were also reviewed. Results—Obesity medications approved for long-term use, when prescribed with lifestyle interventions, produce additional weight loss relative to placebo ranging from approximately 3% of initial weight for orlistat and lorcaserin to 9% for top-dose (15/92mg) phentermine/topiramateER at 1y. The proportion of patients achieving clinically-meaningful (≥5%) weight loss ranges from 37–47% for lorcaserin, 35–73% for orlistat, and 67–70% for top-dose phentermine/ topiramate-ER. All three produce greater improvements in many cardiometabolic risk factors than placebo, but no obesity medication has been shown to reduce cardiovascular morbidity or mortality. Most prescriptions are for noradrenergic medications, despite their approval only for short-term use and limited data for their long-term safety and efficacy. Conclusions/Relevance—Medications approved for long-term obesity treatment, when used as an adjunct to lifestyle intervention, lead to greater mean weight loss and an increased likelihood of achieving clinically-meaningful 1-year weight loss relative to placebo. By discontinuing medication in patients who do not respond with weight loss ≥5%, clinicians can decrease their patients' exposure to the risks and costs of drug treatment when there is little prospect of long-term benefit.
@article{yanovski_long-term_2014-1,
title = {Long-term {Drug} {Treatment} for {Obesity}: {A} {Systematic} and {Clinical} {Review}},
volume = {311},
issn = {0098-7484},
shorttitle = {Long-term {Drug} {Treatment} for {Obesity}},
url = {http://jama.jamanetwork.com/article.aspx?doi=10.1001/jama.2013.281361},
doi = {10.1001/jama.2013.281361},
abstract = {Objective—Conduct a systematic review of medications currently approved in the US for obesity treatment in adults. We also discuss off-label use of medications studied for obesity and provide considerations for obesity medication use in clinical practice. Evidence Acquisition—A PubMed search from inception through September, 2013 was performed to find meta-analyses, systematic reviews, and randomized, placebo-controlled trials for currently-approved obesity medications lasting ≥1y, that had a primary or secondary outcome of body weight, included ≥50 participants per group, reported ≥50\% retention, and reported results on an intention-to-treat basis. Studies of medications approved for other purposes but tested for obesity treatment were also reviewed. Results—Obesity medications approved for long-term use, when prescribed with lifestyle interventions, produce additional weight loss relative to placebo ranging from approximately 3\% of initial weight for orlistat and lorcaserin to 9\% for top-dose (15/92mg) phentermine/topiramateER at 1y. The proportion of patients achieving clinically-meaningful (≥5\%) weight loss ranges from 37–47\% for lorcaserin, 35–73\% for orlistat, and 67–70\% for top-dose phentermine/ topiramate-ER. All three produce greater improvements in many cardiometabolic risk factors than placebo, but no obesity medication has been shown to reduce cardiovascular morbidity or mortality. Most prescriptions are for noradrenergic medications, despite their approval only for short-term use and limited data for their long-term safety and efficacy. Conclusions/Relevance—Medications approved for long-term obesity treatment, when used as an adjunct to lifestyle intervention, lead to greater mean weight loss and an increased likelihood of achieving clinically-meaningful 1-year weight loss relative to placebo. By discontinuing medication in patients who do not respond with weight loss ≥5\%, clinicians can decrease their patients' exposure to the risks and costs of drug treatment when there is little prospect of long-term benefit.},
language = {en},
number = {1},
urldate = {2019-05-02},
journal = {JAMA},
author = {Yanovski, Susan Z. and Yanovski, Jack A.},
month = jan,
year = {2014},
pages = {74},
file = {Yanovski and Yanovski - 2014 - Long-term Drug Treatment for Obesity A Systematic.pdf:/Users/neil.hawkins/Zotero/storage/R9CSACHN/Yanovski and Yanovski - 2014 - Long-term Drug Treatment for Obesity A Systematic.pdf:application/pdf},
}
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All three produce greater improvements in many cardiometabolic risk factors than placebo, but no obesity medication has been shown to reduce cardiovascular morbidity or mortality. Most prescriptions are for noradrenergic medications, despite their approval only for short-term use and limited data for their long-term safety and efficacy. Conclusions/Relevance—Medications approved for long-term obesity treatment, when used as an adjunct to lifestyle intervention, lead to greater mean weight loss and an increased likelihood of achieving clinically-meaningful 1-year weight loss relative to placebo. 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