Drugs

, Volume 65, Issue 10, pp 1391–1418

Pharmacotherapy for Obesity

  • Lisa L. Ioannides-Demos
  • Joseph Proietto
  • John J. McNeil
Review Article

DOI: 10.2165/00003495-200565100-00006

Cite this article as:
Ioannides-Demos, L.L., Proietto, J. & McNeil, J.J. Drugs (2005) 65: 1391. doi:10.2165/00003495-200565100-00006

Abstract

Pharmacotherapy for the management of obesity is primarily aimed at weight loss, weight loss maintenance and risk reduction, and has included thyroid hormone, amphetamines, phentermine, amfepramone (diethylpropion), phenylpropanolamine, mazindol, fenfluramines and, more recently, sibutramine and orlistat. These agents decrease appetite, reduce absorption of fat or increase energy expenditure.

Primary endpoints used to evaluate anti-obesity drugs most frequently include mean weight loss, percentage weight loss and proportion of patients losing ≥5% and ≥10% of initial body weight. Secondary endpoints may include reduction in body fat, risk factors for cardiovascular disease and the incidences of diseases such as diabetes mellitus.

Most pharmacotherapies have demonstrated significantly greater weight loss in patients on active treatment than those receiving placebo in short-term (≤1 year) randomised controlled trials of pharmacological treatment in conjunction with a calorie-controlled diet or lifestyle intervention. The evidence of long-term efficacy is limited to sibutramine (2 years) and orlistat (4 years). These are the only drugs currently approved for the long-term management of obesity in adults. Sibutramine recipients randomised following 6 months’ treatment to either sibutramine or placebo demonstrated significantly better weight maintenance at 2 years than those taking placebo (p < 0.001), with ≥10% loss of initial bodyweight in 46% of patients. For patients taking orlistat, weight loss was 2.2kg greater than those on placebo at 4 years (p < 0.001), with significantly more patients achieving ≥10% loss of initial bodyweight (26.2% and 15.6%, respectively; p < 0.001).

Other drugs that have been evaluated for weight loss include ephedrine, the antidepressants fluoxetine and bupropion, and the antiepileptics topiramate and zonisamide. Two clinical trials with fluoxetine both reported no significant difference in weight loss compared with placebo at 52 weeks. Clinical trials evaluating ephedrine, bupropion, topiramate and zonisamide have demonstrated significantly greater weight loss than placebo but have been limited to 16–26 weeks’ treatment.

A major obstacle to the evaluation of the clinical trials is the potential bias resulting from low study completion rates. Completion rates varied from 52.8% of phentermine recipients in a 9-month study, to 40% of fenfluramine recipients in a 24-week comparative study with phentermine and 18% of amfepramone recipients in a 24-week study. One-year completion rates range from 51% to 73% for sibutramine and from 66% to 85% for orlistat. Other potential sources of bias include run-in periods and subsequent patient selection based on compliance or initial weight loss.

Several potential new therapies targeting weight loss and obesity through the CNS pathways or peripheral adiposity signals are in early phase clinical trials. Over the next decade the drug treatment of obesity is likely to change significantly because of the availability of new pharmacotherapies to regulate eating behaviours, nutrient partitioning and/or energy expenditure.

Copyright information

© Adis Data Information BV 2005

Authors and Affiliations

  • Lisa L. Ioannides-Demos
    • 1
  • Joseph Proietto
    • 2
  • John J. McNeil
    • 1
  1. 1.Department of Epidemiology and Preventive MedicineMonash UniversityMelbourneAustralia
  2. 2.Department of MedicineUniversity of Melbourne, Repatriation HospitalMelbourneAustralia
  3. 3.National Health and Medical Research Council Centre for Clinical Research Excellence in Therapeutics, Department of Epidemiology & Preventive MedicineMonash University — Central & Eastern Clinical School, The Alfred HospitalMelbourneAustralia

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