title: Adherence to weight loss medications; post-marketing study from HMO pharmacy data of one million individuals.
abstract: BACKGROUND
  Post-marketing data on weight-loss medications in free living population are a necessary adjunct to data from clinical trials.
  
  
  METHODS
  We conducted a population-based analysis of first-time medication users based on HMO pharmacy purchasing data serving > one million adults.
  
  
  RESULTS
  During 5 years, usage of orlistat and sibutramine more than doubled and rates were higher during the months May-Aug. As compared to non-users (n = 1,038,828), annual weight-loss drug users (n = 7175) had higher women proportion, body-mass-index (BMI), bariatric surgery history, and usage of diabetes, depression, and cardiovascular medications (p < 0.001 for all). Among users, men had higher BMI (34.4 kg/m(2) vs. 32.5 kg/m(2)), prevalence of diabetes (25.4% vs. 10.7%) and heart disease (14.2% vs. 3.5%) than women. Mean duration of purchasing weight-loss medications was 2.1 months for orlistat and 2.9 months for sibutramine. Fewer than 2% completed 12 months of weight-loss medication therapy. Among the 25% who continued to purchase at least 4 months, BMI (sub-group analysis) reduced from 33.02 kg/m(2) to 32.04 kg/m(2) (p < 0.001). In a multivariate model, long-term adherence (≥ 4 months) to weight-loss medications was associated with use of sibutramine vs. orlistat (OR = 2.08; 95%CI: 1.76-2.45), and prevalence of diabetes (OR = 1.20; 95%CI: 1.01-1.25). Age, gender, and baseline BMI were not associated with long-term adherence.
  
  
  CONCLUSIONS
  Usage of weight-loss drugs is higher among diabetes patients. However, the poor adherence to therapy is substantially below levels reported in clinical trials.
authors: Research and Evaluation Unit, Maccabi Healthcare Services, Tel-Aviv, Israel.
authors: Beatriz
authors: B
authors: Hemo
authors: Ronit
authors: R
authors: Endevelt
authors: Avi
authors: A
authors: Porath
authors: Meir J
authors: MJ
authors: Stampfer
authors: Iris
authors: I
authors: Shai
mesh_terms: D000328:Adult; D000704:Analysis of Variance; D019440:Anti-Obesity Agents / Q000627:therapeutic use*; D015992:Body Mass Index; D015897:Comorbidity; D003503:Cyclobutanes / Q000627:therapeutic use*; D003920:Diabetes Mellitus / Q000453:epidemiology; D005260:Female; D019538:Health Care Surveys; D006279:Health Maintenance Organizations / Q000706:statistics & numerical data*; D006801:Humans; D007356:Insurance, Pharmaceutical Services / Q000706:statistics & numerical data*; D007557:Israel / Q000453:epidemiology; D007783:Lactones / Q000627:therapeutic use*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology; D016017:Odds Ratio; D000077403:Orlistat; D011358:Product Surveillance, Postmarketing; D012042:Registries; D013997:Time Factors; D016896:Treatment Outcome; D015431:Weight Loss / Q000187:drug effects*; D055815:Young Adult; D016903:Drug Monitoring
chemical_list: D019440:Anti-Obesity Agents; D003503:Cyclobutanes; D007783:Lactones; D000077403:Orlistat; C058254:sibutramine