TABLE 6.
Adherence, persistence, and discontinuation of AOMs
| Study | Study population | Adherence | Persistence | Discontinuations | AOM comparisons |
|---|---|---|---|---|---|
| ORLISTAT: PROSPECTIVE | |||||
| Hollywood and Ogden 14 | General obesity | Self‐rated total adherence, 30.4% | 47.5% discontinued by 6 months | ||
| Schwartz et al. 17 | ORL used for median 90% of days since study enrollment | 8.5% discontinued due to AEs | |||
| Wirth 18 | Physician‐rated compliance: excellent, 21.3%; good/very good, 61.8%; moderate, 10.7%; inadequate, 5.1%; missing, 1.1% a | Mean duration use, 7.1 months | |||
| ORLISTAT: RETROSPECTIVE | |||||
| Acharya et al. 22 ; Perrio et al. 44 | General obesity | 30.3% discontinued in first 3 months; 68.9% by study end | |||
| Beermann et al. 25 | Complete adherence to approved indication, 6.5% b | ||||
| Gorgojo‐Martínez et al. 32 |
Persistence: 3–6 months, 64.8%; 12 months, 46.8%; end of follow‐up, 19.5% Interrupted therapy at least once for ≥ 7 days and restarted within follow‐up period, 35.8% |
Persistence: ORL < LIRA | |||
| Grabarczyk 33 | 6‐month MPR ≥ 80%, 17.5%; MPR, 0.50 (0.26) | Adherence: ORL < PHEN/TPM | |||
| Hemo et al. 35 |
Persistence: ≥ 4 months, 15.5% Average duration of therapy, 2.1 months |
Persistence: SIB > ORL (p < 0.001) | |||
| Padwal et al. 43 | Persistence: 6 months, 18%; 1 year, 6%; 2 years, 2% | ||||
| Allie et al. 24 | T2DM | 44% discontinued within 3 months of initiation | |||
| Graham et al. 34 | ORL vs. ORL + WL program: no difference in adherence (p = 0.865) c | Discontinued within 6 months: 34% (all patients); 17% (ORL); 61% (ORL + WL program) (p = 0.004 vs. ORL alone) | |||
| Rowe et al. 16 | DM (91% T2DM) | 18% discontinued within 6 months | |||
| Horie et al. 38 | ≥ 60 years | Mean (SD) duration of therapy, 8.7 (5.0) months | |||
| PHENTERMINE: PROSPECTIVE | |||||
| Kim et al. 15 | General obesity | Good compliance in 26.3% d |
62% completed 12‐week treatment |
9.0% discontinued within 12 weeks due to AEs | |
| PHENTERMINE: RETROSPECTIVE | |||||
| Grabarczyk 33 | General obesity | 6‐month MPR ≥ 80%, 29.4%; MPR, 0.57 (0.29) | |||
| Li et al. 41 |
8.3% of male patients discontinued by week 8 3.9% of female patients discontinued by week 4; 7.8% by week 8 No further discontinuations by week 12 |
||||
| Schwartz et al. 52 | Surgical | No discontinuations due to hypertension, cardiac arrythmias, or insomnia; one discontinuation each due to headaches and nausea | |||
| PHENTERMINE/TOPIRAMATE: RETROSPECTIVE | |||||
| Grabarczyk 33 | General obesity | 6‐month MPR ≥ 80%, 38.2%; MPR, 0.65 (0.26) | Adherence: PHEN/TPM > ORL (p < 0.05) | ||
| Ganguly et al. 31 | 6‐month PDC ≥ 80%, 20.6%; PDC, 0.47 (0.29) |
Persistence: 3 months, 49.0%; 6 months, 27.3%; 9 months, 16.8%; 12 months, 10.9% ≥ 1 prescription refill beyond index claim, 72% Switch to alternative AOM, 13.7% (to LORC, 27.3%; to LIRA, 28.0%; to NTX/BPN, 44.8%) |
Persistence: PHEN/TPM < LIRA Discontinuation: PHEN/TPM > LIRA |
||
| Schwartz et al. 52 | Surgical | No discontinuations due to hypertension, cardiac arrhythmias, or insomnia | |||
| LIRAGLUTIDE: PROSPECTIVE | |||||
| Suliman et al. 19 | General obesity | 20% discontinued after median 108 days; 6.7% of study population due to AEs | |||
| Wharton et al. 20 | Surgical | Persistence: 36.8% at 1 year | 23.9% discontinued by 1 year | ||
| LIRAGLUTIDE: RETROSPECTIVE | |||||
| Ganguly et al. 31 | General obesity | 6‐month PDC ≥ 0.80, 27.4%; PDC, 0.56 (0.28) |
Persistence: 3 months, 62.6%; 6 months, 41.8%; 9 months, 33.0%; 12 months, 28.2% Switching in first 6 months, 3.7% (to LORC, 21.7%; to NTX/BPN, 54.6%; to PHEN/TPM, 23.7%) |
Persistence: LIRA > LORC, PHEN/TPM, NTX/BPN at 6 and 12 months (p < 0.001) Discontinuation: LIRA < LORC (HR, 0.46), NTX/BPN (HR, 0.48), PHEN/TPM (HR, 0.64) (p < 0.0001) |
|
| Gorgojo‐Martínez et al. 32 |
Persistence: 3–6 months, 75%; 12 months, 61%; end of follow‐up, 55% Therapy interruption at least once for ≥ 7 days, with restart within follow‐up, 11% |
Persistence: LIRA > ORL at 3–6 months (p = 0.052), 12 months (p = 0.011), and end of follow‐up (p < 0.0001) Therapy interruption: LIRA < ORL (p < 0.0001) |
|||
| Wharton et al. 48 | Persistence: ≥ 4 months, 67.5%; ≥ 6 months, 53.7% | Discontinuations: ≥ 4‐month persistent cohort, 28.1%; ≥ 6‐month persistent cohort, 51.5% | |||
| NALTREXONE/BUPROPION: RETROSPECTIVE | |||||
| Ganguly et al. 31 | General obesity | 6‐month PDC ≥ 80%, 11.1%; PDC, 0.38 (0.26) |
Persistence: 3 months, 34.2%; 6 months, 18.1%; 9 months, 12.7%; 12 months, 9.2% Switching to alternative AOM, 6.9% (to LIRA, 40.7%; LORC, 35.1%; PHEN/TPM, 24.2%) |
Persistence: NTX/BPN < LIRA Discontinuation: NTX/BPN > LIRA |
|
Abbreviations: AE, adverse event; AOM, anti‐obesity medication; BMI, body mass index; BPN, bupropion; DM, diabetes mellitus; LIRA, liraglutide; LORC, lorcaserin; MPR, medication possession ratio; NTX, naltrexone; ORL, orlistat; PDC, proportion of days covered; PHEN, phentermine; SD, standard deviation; SIB, sibutramine; T2DM, type 2 diabetes mellitus; TPM, topiramate; WL, weight loss.
Rated on a 5‐point scale; unclear from the publication whether compliance just relates to medication adherence or to all aspects of management, including dietary restrictions.
Complete adherence to approved indication characterized as having correct BMI at initiation, approved weight reduction during the pre‐drug diet period, and continued orlistat treatment after 3 months only with an approved weight reduction of ≥ 5%.
Adherence for the ORL + WL program group was defined as patients taking 120–360 mg/d, as the number of pills per day may vary with number of meals consumed. Thus, if ≥ 1 dose was ingested daily, the patient was considered adherent. Adherence for ORL‐only patients was defined as taking ≥ 80% of their weekly dose or having computerized prescription records indicating sufficient medication supply between visits.
Compliance rate was measured according to the percentage of patients who took medication during the study period; if the rate was > 80%, compliance was considered good and if < 80%, it was considered poor.