Long term pharmacotherapy for obesity and overweight: updated meta-analysis.
OBJECTIVE
To summarise the long term efficacy of anti-obesity drugs in reducing weight and improving health status.


METHODS
Updated meta-analysis of randomised trials.


METHODS
Medline, Embase, the Cochrane controlled trials register, the Current Science meta-register of controlled trials, and reference lists of identified articles. All data sources were searched from December 2002 (end date of last search) to December 2006.


METHODS
Double blind randomised placebo controlled trials of approved anti-obesity drugs used in adults (age over 18) for one year or longer.


RESULTS
30 trials of one to four years' duration met the inclusion criteria: 16 orlistat (n=10 631 participants), 10 sibutramine (n=2623), and four rimonabant (n=6365). Of these, 14 trials were new and 16 had previously been identified. Attrition rates averaged 30-40%. Compared with placebo, orlistat reduced weight by 2.9 kg (95% confidence interval 2.5 kg to 3.2 kg), sibutramine by 4.2 kg (3.6 kg to 4.7 kg), and rimonabant by 4.7 kg (4.1 kg to 5.3 kg). Patients receiving active drug treatment were significantly more likely to achieve 5% and 10% weight loss thresholds. Orlistat reduced the incidence of diabetes and improved concentrations of total cholesterol and low density lipoprotein cholesterol, blood pressure, and glycaemic control in patients with diabetes but increased rates of gastrointestinal side effects and slightly lowered concentrations of high density lipoprotein. Sibutramine improved [corrected] concentrations of high density lipoprotein cholesterol and triglycerides [corrected] Rimonabant improved concentrations of high density lipoprotein cholesterol and triglycerides, blood pressure, and glycaemic control in patients with diabetes but increased the risk of mood disorders.


CONCLUSIONS
Orlistat, sibutramine, and rimonabant modestly reduce weight, have differing effects on cardiovascular risk profiles, and have specific adverse effects.
Rucker
Diana
D
Department of Medicine, University of Alberta, Edmonton, AB, Canada.
Padwal
Raj
R
Li
Stephanie K
SK
Curioni
Cintia
C
Lau
David C W
DC
D019440:Anti-Obesity Agents / Q000627:therapeutic use*; D004311:Double-Blind Method; D006801:Humans; D007783:Lactones / Q000627:therapeutic use*; D008134:Long-Term Care; D009765:Obesity / Q000188:drug therapy; D000077403:Orlistat; D050177:Overweight / Q000188:drug therapy*; D016032:Randomized Controlled Trials as Topic
D019440:Anti-Obesity Agents; D007783:Lactones; D000077403:Orlistat