MedicalResearch.com Interview with:
Siddharth Singh, MD, MS
Postdoctoral Fellow, NLM/NIH Clinical Informatics Fellowship
Division of Biomedical Informatics
Clinical Assistant Professor of Medicine, Division of Gastroenterology, Department of Internal Medicine,
University of California
San Diego, La Jolla
MedicalResearch.com: What is the background for this study? What are the main findings?
Dr. Singh: Over the last 4 years, four new medications have been approved for long-term use for weight loss by the FDA. We sought to evaluate the comparative effectiveness and tolerability of these medications through a systematic review and network meta-analysis. Based on 28 trials in over 29,000 overweight or obese patients, we observed that magnitude of weight loss achieved with these agents is variable, ranging from 2.6kg with orlistat to 8.8kg with phentermine-topiramate. Over 44-75% of patients are estimated to lose at least 5% body weight, and 20-54% may lose more than 10% of body weight; phentermine-topiramate was the most efficacious, whereas lorcaserin was the best tolerated.
MedicalResearch.com: What should readers take away from your report?
Dr. Singh: Several new options for pharmacological management of obesity are now available, with variable efficacy and tolerability. Some medications, particularly phentermine-topiramate and liraglutide achieve higher weight loss than others, but each medication has its side effect profiles. So, it’ll require a thoughtful risk-benefit analysis on part of the primary care physician to choose the right medication for the right patient. Moreover, weight loss medications may help kick-start a motivated patient on a journey for weight loss. However, the long-term efficacy and safety of these agents is unclear (all trials were for 1 year), and comprehensive lifestyle interventions still form the backbone for a sustained weight loss.
MedicalResearch.com: What recommendations do you have for future research as a result of this study?
Dr. Singh: There is a striking paucity of head-to-head trials of different medications. Future comparative effectiveness studies of different medications, as well different strategies of using these medications in conjunction with lifestyle and endoscopic bariatric interventions are needed. Moreover, prospective observational studies on the real-world effectiveness, tolerability and safety of these agents are warranted.
MedicalResearch.com: Is there anything else you would like to add?
Dr. Singh: It’s encouraging to see innovation in the field of obesity, with a plethora of options for pharmacological agents, upcoming endoscopic techniques and seeing long-term effectiveness of surgical procedures. Future comparative effectiveness studies would help inform the right strategy of using these interventions for a particular patient, to achieve and maintain optimal weight loss.
MedicalResearch.com: Thank you for your contribution to the MedicalResearch.com community.
Khera R, Murad M, Chandar AK, et al. Association of Pharmacological Treatments for Obesity With Weight Loss and Adverse Events: A Systematic Review and Meta-analysis. JAMA. 2016;315(22):2424-2434. doi:10.1001/jama.2016.7602.
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