Weight-loss drugs have little effect on cardiometabolic profile

Last Updated: 2018-01-10

By Anne Harding

NEW YORK (Reuters Health) - The five weight-loss medications now on the market have only "modest" effects on cardiometabolic risk profile, according to a new systematic review and network meta-analysis.

"We need to better understand the long-term cardiovascular benefits of these medications when we prescribe to our patients," Dr. Siddharth Singh of the University of California, San Diego in La Jolla, one of the study's authors, told Reuters Health in a telephone interview.

Patients lose an additional 2.6 kg to 8.8 kg compared with placebo when taking orlistat, lorcaserin, naltrexone-bupropion, liraglutide or phenterimine-topiramate, Dr. Singh and his team note in Gastroenterology, online January 3. From 20% to 54% of patients lose at least 10% of their weight with a year of treatment, they add, but it is unclear if patients also see improvements in their cardiometabolic profile.

To investigate, the researchers reviewed 28 randomized controlled trials of FDA-approved weight loss drugs including more than 29,000 patients in all. Eight of the trials were in patients with diabetes.

Overall, patients on weight-loss drugs averaged a 4.0 mg/dL reduction in blood glucose compared to placebo, the researchers found. Liraglutide produced the largest drop in fasting glucose, of 15.6 mg/dL, while orlistat led to an 8.0 mg/dL reduction. None of the other drugs had a significant effect on fasting blood glucose.

LDL cholesterol fell by a mean of 0.1 mg/dL with weight-loss drug treatment while HDL increased by 0.1 mg/dL. The effect on blood pressure was minimal, with systolic and diastolic blood pressure reduced by about 2 mmHg. All medications were associated with modest decreases in waist circumference, ranging from 2.3 cm to 7 cm.

While the benefits are modest, Dr. Singh noted, they are synergistic. When choosing whether to prescribe a weight-loss medication, he added, "you need to keep in mind the side effect profile of these medications and also what your goal is." More data is needed on the long-term safety and effectiveness of weight-loss therapies, the researcher said, as well as to identify the subset of patients who are most likely to respond to a particular drug.

"Once you are able to identify and link the appropriate patient to the right drug, then the anticipated benefit of the treatment is likely to be larger than when we include all comers in these trials," he said.

SOURCE: http://bit.ly/2qPJBor

Gastroenterology 2018.