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Meta-Analysis
. 2007 Dec 8;335(7631):1194-9.
doi: 10.1136/bmj.39385.413113.25. Epub 2007 Nov 15.

Long Term Pharmacotherapy for Obesity and Overweight: Updated Meta-Analysis

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Free PMC article
Meta-Analysis

Long Term Pharmacotherapy for Obesity and Overweight: Updated Meta-Analysis

Diana Rucker et al. BMJ. .
Free PMC article

Erratum in

  • BMJ. 2007 Nov 24;335(7629). doi: 10.1136/bmj.39406.519132.AD

Abstract

Objective: To summarise the long term efficacy of anti-obesity drugs in reducing weight and improving health status.

Design: Updated meta-analysis of randomised trials.

Data sources: 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.

Studies reviewed: 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.

Conflict of interest statement

Competing interests: DCWL has received consulting and speaker fees, research grants, and travel assistance from makers of anti-obesity drugs.

Figures

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Fig 1 Results of search for relevant studies
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Fig 2 Placebo subtracted weight reduction (kg) with orlistat
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Fig 3 Placebo subtracted weight reduction (kg) with sibutramine
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Fig 4 Placebo subtracted weight reduction (kg) with rimonabant
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Fig 5 Funnel plot of orlistat studies for weight loss

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