Table 1.
Anti-obesity medication | Type of agent/mechanism of action [23] | Trial information | Percentage of patients achieving categorial weight loss at 1 year | |||
---|---|---|---|---|---|---|
≥ 5% (or > 5%) |
≥ 10% (or > 10%) |
Percentage of patients achieving weight loss maintenance at 2 years | ||||
Liraglutide |
· GLP-1RA · Reduces appetite and food cravings [21] · Increases satiety · Alters food preference and reward pathways [21] |
Astrup et al., 2009; Astrup et al., 2012: placebo-controlled, randomized, 20-week trial for liraglutide (1.2, 1.8, 2.4, and 3.0 mg QD) with open-label comparator (orlistat 120 mg TID) + 84-week extension in patients with BMI 30–40 kg/m2 Patients were on a 500-kcal/day energy-deficient diet and increased their physical activity |
(Liraglutide 3.0 mg; orlistat; placebo) 73%; 44%; 28% (liraglutide vs. placebo or orlistat, p ≤ 0.0001) |
(Liraglutide 3.0 mg; orlistat; placebo) 37%; 14%; 10% |
(Liraglutide 2.4/3.0 mg vs. orlistat) ≥ 5% weight loss: 52% vs. 29% (p < 0.001) ≥ 10% weight loss: 26% vs. 16% (p = 0.04) |
|
Pi-Sunyer et al., 2015: placebo-controlled, double-blind, randomized, 56-week trial of liraglutide 3.0 mg QD in patients with BMI ≥ 30 kg/m2 (or ≥ 27 kg/m2 with dyslipidemia or hypertension) Patients received counseling on lifestyle modification |
(Liraglutide 3.0 mg; placebo) 63%; 27% (p < 0.001) |
(Liraglutide 3.0 mg; placebo) 33%; 11% (p < 0.001) |
NR | |||
Davies et al., 2015: placebo-controlled, randomized, double-blind, parallel-group 56-week trial of liraglutide 1.8 and 3.0 mg QD in patients with BMI ≥ 27 kg/m2 with diabetes taking 0–3 OADs Patients were on a 500-kcal/day energy-deficient diet and increased their physical activity |
(Liraglutide 3.0 mg; placebo) 54%; 21% (p < 0.001) |
(Liraglutide 3.0 mg; placebo) 25%; 7% (p < 0.001) |
NR | |||
Wadden et al., 2013: placebo-controlled, double-blind, randomized, 56-week trial of liraglutide 3.0 mg QD in patients with BMI ≥ 30 (or ≥ 27 with comorbidity) kg/m2 after low-calorie-diet-induced weight loss Patients received diet and exercise counseling |
(Liraglutide 3.0 mg; placebo)a 51%; 22% (p < 0.0001) |
(Liraglutide 3.0 mg; placebo)a 26%; 6% (p < 0.0001) |
NR | |||
Wadden et al., 2020b: placebo-controlled, double-blind, randomized, 56-week trial of liraglutide 3.0 mg QD plus IBT in patients with BMI ≥ 30 kg/m2 |
(Liraglutide 3.0 mg; placebo) 62%; 34% (p = 0.0003) |
(Liraglutide 3.0 mg; placebo) 31%; 20% (p = 0.0469) |
NR | |||
Garvey et al., 2020: placebo-controlled, double-blind, randomized, 56-week trial of liraglutide 3.0 mg QD plus IBT in patients with BMI of ≥ 27 kg/m2 and diabetes treated with basal insulin and ≤ 2 OADs |
(Liraglutide 3.0 mg; placebo) 52%; 24.0% (p < 0.0001) |
(Liraglutide 3.0 mg; placebo) 23%; 7% (p < 0.0001) |
NR | |||
Naltrexone-bupropion |
· Naltrexone: opioid antagonist · Bupropion: aminoketone antidepressant [62] ⋅ Suppresses appetite |
Greenway et al., 2010: placebo-controlled, double-blind, randomized, 56-week trial of naltrexone-bupropion (NB16 and NB32b) BID in patients with BMI ≥ 30 (or ≥ 27 with comorbidity) to 45 kg/m2 Patients were on a mild hypocaloric diet and exercise |
(NB16; NB32; placebo) 39%; 48%; 16% (NB16/NB32 vs. placebo, both p < 0.0001) |
(NB16; NB32; placebo) 20%; 25%; 7% (NB16/NB32 vs. placebo, both p < 0.0001) |
NR | |
Apovian et al., 2013: placebo-controlled, double-blind, randomized, 56-week trial of naltrexone-bupropion (NB32) BID in patients with BMI ≥ 30 (or ≥ 27 with controlled hypertension and/or dyslipidemia) to 45 kg/m2 Patients were on a 500-kcal/day energy-deficient diet, increased physical activity, and behavioral modification advice |
(NB32; placebo) 51%; 17% (p < 0.001) |
(NB32; placebo) 28%; 6% (p < 0.001) |
NR | |||
Wadden et al., 2011: placebo-controlled, double-blind, randomized, 56-week trial of naltrexone-bupropion (NB32) QD and BMOD in patients with BMI ≥ 30 (or ≥ 27 with controlled hypertension and/or dyslipidemia) to 45 kg/m2 |
(NB32; placebo) 66%; 43% (p < 0.001) |
(NB32; placebo) 42%; 20% (p < 0.001) |
NR | |||
Hollander et al., 2013: placebo-controlled, double-blind, randomized, 56-week trial of naltrexone-bupropion (NB32) QD in patients with BMI ≥ 27 and ≤ 45 kg/m2 and type 2 diabetes treated with or without OADs Patients were on a 500-kcal/day energy-deficient diet, dietary counseling and advice on behavioral modification, including instructions to increase physical activity |
(NB32; placebo) 45%; 19% (p < 0.001) |
(NB32; placebo) 19%; 6% (p < 0.001) |
NR | |||
Orlistat |
· Reversible inhibitor of gastrointestinal lipases [65] · Inhibits fat absorption |
Hauptman et al., 2000: placebo-controlled, double-blind, randomized, 2-year trial of orlistat (60 and 120 mg TID) in patients with BMI 30–44 kg/m2 Patients were on an energy-deficient diet |
(Orlistat 60 mg; orlistat 120 mg; placebo) 49%; 51%; 31% (Orlistat 60 mg/120 mg vs. placebo, both p < 0.001) |
(Orlistat 60 mg; orlistat 120 mg; placebo) 24%; 29%; 11% (Orlistat 60 mg/120 mg vs. placebo, both p < 0.001) |
(Orlistat 60 mg; orlistat 120 mg; placebo) ≥ 5% weight loss: 34%; 34%; 24% (Orlistat 60 mg vs. placebo: p = 0.03; orlistat 120 mg vs. placebo: p = 0.02) ≥ 10% weight loss: 15%; 19%; 7% (Orlistat 60 mg vs. placebo: p = 0.008; orlistat 120 mg vs. placebo: p = 0.001) |
|
Rössner et al., 2000: placebo-controlled, double-blind, randomized, 2-year trial of orlistat (60 and 120 mg) TID in patients with BMI 28–43 kg/m2 Patients were on a 600-kcal/day energy-deficient diet |
NR |
(Orlistat 60 mg; orlistat 120 mg; placebo) 31%; 38%; 19% (Orlistat 60 mg vs. placebo: p = 0.002; orlistat 120 mg vs. placebo: p = 0.001) |
(Orlistat 60 mg; orlistat 120 mg; placebo) > 10% weight loss: 29%; 28%; 19% (Orlistat 60 mg/120 mg vs. placebo: both p < 0.05) |
|||
Phentermine |
· Phentermine: sympathomimetic amine anorectic [63] · Suppresses appetite |
Kang et al., 2010: placebo-controlled, double-blind, randomized, 12-week trial of phentermine 30 mg QD in patients with obesity and controlled diabetes, hypertension, and dyslipidemia |
(Phentermine; placebo) 96%; 21% (p < 0.001) |
(Phentermine; placebo) 63%; 5% (p < 0.001) |
NR | |
Phentermine-topiramate |
· Phentermine: sympathomimetic amine anorectic [64] · Topiramate: anti-epileptic drug · Suppresses appetite |
Allison et al., 2012: placebo-controlled, randomized, 56-week trial of PT (3.75/23 mg or 15/92 mg) QD added to a reduced-energy diet in patients with BMI ≥ 35 kg/m2 Patients were advised to follow a 500-kcal/day energy-deficient diet and received standardized diet and lifestyle-modification counseling |
(PT 3.75/23 mg; PT 15/92 mg; placebo) 45%; 67%; 17% (PT 3.75/23 mg/15/92 mg vs. placebo, both p < 0.0001) |
(PT 3.75/23 mg; PT 15/92 mg; placebo) 19%; 47%; 3% (PT 3.75/23 mg/15/92 mg vs. placebo, both p < 0.0001) |
NR | |
Gadde et al., 2011; Garvey et al., 2012: placebo-controlled, double-blind, randomized, 108-week trial of PT (7.5/46 mg or 15/92 mg) QD in patients with BMI 27–45 kg/m2 and cardiometabolic disease Patients received standardized diet and lifestyle-modification counseling |
(PT 7.5/46 mg; PT 15/92 mg; placebo) 62%; 70%; 21% (PT 5/46 mg/15/92 mg vs. placebo, both p < 0.0001) |
(PT 7.5/46 mg; PT 15/92 mg; placebo) 37%; 48%; 7% (PT 5/46 mg/15/92 mg vs. placebo, both p < 0.0001) |
(PT 7.5/46 mg; PT 15/92 mg; placebo) ≥ 5% weight loss: 75%; 79%; 30% ≥ 10% weight loss: 50%; 54%; 12% (PT 7.5/46 mg/15/92 mg vs. placeb, both p < 0.0001) |
Percentages are rounded up to one decimal place
BID two times a day, BMI body mass index, BMOD intensive behavior modification, GLP-1RA glucagon-like peptide 1 receptor agonist, IBT intensive behavioral therapy, NR not reported, OAD oral antihyperglycemic drug, PT phentermine-topiramate, QD once-daily, TID three times per day
aBased on patients achieving ≥ 5% weight loss during the run-in period
bNB16: sustained-release naltrexone 16 mg per day plus sustained-release bupropion 360 mg per day combined in fixed-dose tablets; NB32: sustained-release naltrexone 32 mg per day plus sustained-release bupropion 360 mg per day combined in fixed-dose tablets