Effectiveness, tolerability and practical application of the newer generation anti-obesity medications

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Objective: Comparison of the efficacy and tolerability of five newer anti-obesity medications to guide clinical decision making, examining bupropion–naltrexone combination, liraglutide, lorcaserin, orlistat, and phentermine–topiramate combination.

Methods: A brief literature review and internet search for high-powered, randomized and placebo-controlled drug trials was conducted. Drug trial information was established for five currently approved anti-obesity medications. Secondarily, a statistical comparison of medications through Number Needed to Treat (NNT) and Number Needed to Harm (NNH) analyses were attempted as a way to provide a clinical analysis across these varied medications. Finally, a commentary about clinical application is issued for each agent accounting for typical side-effects, serious side-effects, mechanism of action and ease of use.

Results: All five agents are currently approved oral medications to lower weight. The NNT range was 3–12, and NNH range was 4–17. The agent with the best NNT is phentermine–topiramate combination (NNT=3) and the agent with the best NNH is bupropion–naltrexone combination (NNH=17).

Conclusion: When considering each patient’s clinical presentation, knowledge of each drug’s mechanism of action, side-effect profile, efficacy, and NNT and NNH values can help in selecting an anti-obesity medication to augment his or her weight loss efforts.

Keywords: anti-obesity, weight loss, Number Needed to Treat (NNT), Number Needed to Harm (NNH), liraglutide, lorcaserin, orlistat, phentermine, topiramate, bupropion, naltrexone.

Abbreviations: 5-HT2C, serotonin 2C receptor; ARR, absolute risk reduction; BLOSSOM, behavioral modification and lorcaserin second study for obesity management; CER, control event rate; EER, experimental event rate; EMA, European medical agency; FDA, food and drug administration; GLP-1, glucagon-like peptide-1; NDA, new drug application; NNH, number needed to harm; NNT, number needed to treat; RCT, randomized control trial.

Citation: MacDaniels JS, Schwartz TL. Effectiveness, tolerability and practical application of the newer generation anti-obesity medications. Drugs in Context 2016; 5: 212291. doi: 10.7573/dic.212291

Contributions: Thomas L. Schwartz conceived the idea, supervised the preparation of the manuscript, contributed content, streamlined and provided longitudinal editing. Jeffrey S. MacDaniels provided substantial contributions to the literature review, statistical analysis, and co-wrote the manuscript.

Potential conflict of interest: The authors have declared that there are no conflicts of interest regarding this unfunded study. The International Committee of Medical Journal Editors’ (ICMJE) potential Conflicts of Interests form for the author is available for download at: https://www.drugsincontext.com/wp-content/uploads/2016/03/dic.212291-COI.pdf.

Funding declaration: This was an unfunded study.

Acknowledgements: Jeffrey S. MacDaniels would like to thank Thomas L. Schwartz for his help in completing this manuscript.

Copyright: Copyright © 2016 MacDaniels JS, Schwartz TL. Distributed under the terms of the Creative Commons License Deed CC BY 3.0 which allows anyone to copy, distribute, and transmit the article provided it is properly attributed in the manner specified below.

Correct attribution: Copyright © 2016 MacDaniels JS, Schwartz TL. http://dx.doi.org/10.7573/dic.212291. Published by Drugs in Context under Creative Commons License Deed CC BY 3.0.

Article URL: https://www.drugsincontext.com/effectiveness-tolerability-and-practical-application-of-the-newer-generation-anti-obesity-medications

Correspondence: Thomas L. Schwartz MD, Psychiatry Department, 750 E. Adams St, Syracuse, NY 13210, USA. schwartt@upstate.edu

Provenance: Submitted; externally peer reviewed

Submitted: 21 August 2015; Peer review comments to author: 15 September 2015; Published: 8 March 2016

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