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Pharmacotherapy
Obesity Pharmacotherapy Outline
• How to apply drug trial data to clinical practice• Principles of obesity medication use in clinical practice• Medications approved for long-term use
– sibutramine (Meridia)– orlistat (Xenical)
• Medications approved for short term use– phentermine– others rarely used: mazindol, diethylpropion
• Medications for use in special patients– the depressed obese patient – bupropion (Wellbutrin) and venlafaxine
(Effexor)– type 2 diabetes – metformin , pramlintide (Symlin), exendin-4 (Exenatide)– patients with neuropsychiatric problems - topiramate (Topamax) and
zonisamide (Zonegran)
• Medications in development
1. Mean responses describe how patients fare on average.2. The weight loss curves describe the tempo of weight loss.3. The placebo response indicates the strength of the behavioral
approach.
–8
–6
–4
–2
0
0 1 2 3 4 5 6 7 8 9 10 11 12
Mea
n C
hang
e in
Wei
ght
(%)
Drug
Placebo
Treatment MonthNoteunits
Noteplateau
Placebo response indicates behavioral program
Applying Pharmacotherapy Trials to the Practice Setting – 6 Tips
Applying Pharmacotherapy Trials to the Practice Setting – 6 Tips
4. Categorical responses indicate the chance an individual patient has of meeting key response levels, 5% and 10%.
5. Significance levels and n’s are important.
*P < 0.01 vs placebo†P < 0.001 vs placebo
(95)(95)
(107)(107)
0
10
20
30
40
50
60
70
80PlaceboPlacebo
1 mg 1 mg 5 mg 5 mg
10 mg 10 mg 15 mg 15 mg 20 20 30 30
(n=87)(n=87)
(99)(99)
mg (96)mg (96)mg (101)mg (101)
Drug (n)Drug (n)
*
†
†
†
†
*†
††
†
5% Responders 10% Responders
Pat
ien
ts (
%)
(98)(98)
Chances of response
note
Applying Pharmacotherapy Trials to the Practice Setting – 6 Tips
6. There is no placebo effect in weight loss studies. The placebo represents the effect of the behavioral intervention.
WMD (Random)95% CI
Author 9, 2002
Author 5, 2000
Author 4, 2000
Author 3, 1999
Author 2, 1998
Author 1, 1998*
Author 7, 2000
Author 8, 2002
Total (95% CI)
Author 6, 2000
Study or Subcategory
-10 -5 0 105
Metanalyses use placebo-subtracted weight loss and demonstrate the effect of the medication independent of behavioral intervention.
Principles of Obesity Medication Use
• Lifestyle interventions are the foundation of medicating for obesity
• The behavioral approach should be implemented with knowledge of the medication’s mechanism of action – Orlistat with 30% fat diet– Sibutramine with meal plan that takes advantage of its satiety
promotion
• Obesity medications do not cure obesity, just as antihypertensives do not cure hypertension
• Not all patients respond to a weight loss medication. – If the drug’s use is not associated with weight loss within four weeks, it
should be stopped
• Medications work as long as they are used– Weight gain occurs on stopping medications, although there is some
evidence in support of efficacy of intermittent medication
Obesity PharmacotherapyOutline
• How to apply drug trial data to clinical practice• Principles of obesity medication use in clinical practice• Medications approved for long-term use
– sibutramine (Meridia)– orlistat (Xenical)
• Medications approved for short term use– phentermine– others rarely used: mazindol, diethylpropion
• Medications for use in special patients– the depressed obese patient – bupropion (Wellbutrin) and venlafaxine
(Effexor)– type 2 diabetes – metformin , pramlintide (Symlin), exendin-4
(Exenatide)– patients with neuropsychiatric problems - topiramate (Topamax) and
zonisamide (Zonegran)
• Medications in development
Antiobesity Drugs Approved for Long-Term Use: How They Work
Sibutramine Orlistat• FDA approved 1997
• Induces feeling of satiety– Less preoccupation, feeling
satisfied with less food
– Greater control of food
intake
– Need to monitor BP early in
program
• Once daily with or without
food
• FDA approved 1999
• Reduces absorption of
~30% dietary fat– Fat in diet passes
undigested
– Facilitates weight loss
– GI side effects
• 3 times daily with meals
and a vitamin supplement
recommended
Ryan DH et al. Obes Res. 1995;3(suppl 4):553S.
S = sibutramine = norepinephrine = serotonin
Norepinephrine
Serotonin SSSS
SSSS
SSSS
SSSS
Reuptake
Reuptake
Mechanisms of ActionSibutramine’s Active Metabolites Block Serotonin and Norepinephrine Reuptake
Other SNRIs
• Venlafaxine (Effexor)
– Widely used in depression
– Similar side effect profile to sibutramine, small blood pressure increases
– Produces some weight loss
Rudolph RL, Derivan AT. J Clin Psychopharmacol. 1996;16(suppl 2):54S.
Sibutramine Key Facts
• Multiple large clinical trials demonstrating:− Dose-related weight loss occurs for 6 months− Amount of weight loss related to intensity of behavioral
approach− Efficacy in weight loss maintenance demonstrated ≥ 2
years − Weight loss produces benefits in lipids, body composition
and is associated with mean blood pressure decrease− Trials in patients with hypertension and diabetes
• Favorable side effect profile: − No abuse potential− No valvuloplasty, no PPH
• Cautions− Blood pressure should be monitored− Should not use with MAOIs, erythromycin, ketoconazole
Sibutramine Produces Dose-Related Weight Loss
**10 and 15 mg are recommended doses
Placebo (n = 84)Sibutramine, mg (n)
1 (92)
Week
Mea
n W
eigh
t C
hang
e (lb
)
5 (103)
10 (95)
15 (94)
20 (89)
30 (96)
*
*
*
**
0
–5
–10
–15
–200 3 6 9 12 15 18 21 24
Bray GA et al. Obes Res. 1999;7:189.
Approveddose range
The Amount of Weight Loss with Sibutramine Is Related to the Intensity
of the Behavioral Intervention*
Wadden TA et al. Arch Intern Med 2001;161:218-227.
-5.2
-11.5
-17.1
-20
-18
-16
-14
-12
-10
-8
-6
-4
-2
0
% W
eigh
t Cha
nge
at 6
mon
ths
Sibutramine
Sibutramine+ Group Sessions
Sibutramine+ Group Sessions
+ Meal Replacements
* Weight loss at 6 months
STORM: 77% (ITT) Achieved > 5% Weight Loss at Six Months
James WPT et al. Lancet. 2000;356:2119.
*Same diet, exercise for sibutramine, placebo; P 0.001, sibutramine vs placebo for weight maintenance
230
210
1950 122 4 6 8 10 14 16 18 20 22 24
Month
Bod
y W
eigh
t (lb
)
Placebo
Sibutramine
Weight Loss Weight Maintenance
225
220
215
205
200
STORM: Sibutramine Promotes Weight Loss Maintenance*
230
210
1950 122 4 6 8 10 14 16 18 20 22 24
Month
Bod
y W
eigh
t (lb
)
Placebo
Sibutramine
Weight Loss Weight Maintenance
225
220
215
205
200
*Same diet, exercise for sibutramine, placebo; P 0.001, sibutramine vs placebo for weight maintenance
James WPT et al. Lancet. 2000;356:2119.
Following VLCD, Sibutramine Promotes Additional Weight Loss and
Weight Loss Maintenance
Sibutramine
Placebo
= very low calorie diet (VLCD)
P < 0.001 for months 1 to 12, sibutramine vs placebo
Mea
n W
eigh
t (lb
)
Treatment Month
233
229
224
220
217
211
207
202
198
194–1 0 1 2 3 4 5 6 7 8 9 10 11 12
Adapted with permission from Apfelbaum M et al. Am J Med. 1999;106:179.
Three Sibutramine Studies
1Bray GA et al. Obes Res. 1999;7:189. 2Apfelbaum M et al. Am J Med. 1999;106:179.3James WPT et al. Lancet 2000;356:2119-2125.
P 0.001 vs placebo
Percent Achieving Meaningful Weight Loss
67
35
84
54
6763
0
10
20
30
40
50
60
70
80
90
% A
ch
iev
ing
We
igh
t L
os
s
≥ 5%
≥ 10%
6 months treatment 1
12 months treatment 2
24 months treatment 3
Weight Loss with Sibutramine Is Associated with Improvements in Lipids
(STORM Data)
Weight loss = months 1–6; Weight maintenance = months 7–24; *P < 0.001; †P = 0.002; ‡P = 0.005; §P = 0.001 vs placebo
Sibutramine
Placebo
Triglycerides
–25
–20
–15
–10
–5
0
5
0 6 12 18 24
Month Assessed
% C
ha
ng
e
*†*
–25
–20
–15
–10
–5
0
5
0 6 12 18 24
Sibutramine
Placebo
VLDL-Cholesterol
Month Assessed
% C
hange
§‡*
Sibutramine
Placebo
HDL-Cholesterol
0
5
10
15
20
25
0 6 12 18 24
% C
ha
ng
e
Month Assessed
**
Adapted with permission from James WPT et al. Lancet. 2000;356:2119.
Weight Loss with Sibutramine Is Associated with Improvement in Waist Circumference
(STORM data)
NB: Same diet and exercise for both sibutramine and placebo
Sibutramine
44
43
42
41
40
39
38
0 122 4 6 8 10 14 16 18 20 22 24
Wai
st C
ircum
fere
nce
(in.)
Month
Placebo
James WPT et al. Lancet. 2000;356:2119.
Sibutramine and Blood Pressure
• Labeling instructions:
Warning.
Blood pressure and pulse. MERIDIA SUBSTANTIALLY INCREASES BLOOD PRESSURE IN SOME PATIENTS. REGULAR MONITORING OF BLOOD PRESSURE IS REQUIRED WHEN PRESCRIBING MERIDIA. In placebo-controlled obesity studies, MERIDIA 5 to 20 mg once daily was associated with mean increases in systolic and diastolic blood pressure of approximately 1 to 3 mg relative to placebo…
-0.1+1.0*
+2.6*
+3.8*
Dose Related Effects of Sibutramineon Systolic Blood Pressure (SBP)C
hange in S
BP (
mm
Hg)
Sibutramine20 mgn=1126
Sibutramine30 mgn=128
Sibutramine15 mgn=1924
Sibutramine10 mgn=1318
Placebon=1944
0
2
4
6
8
10
-1 * p < 0.05 comparedto placebo
-0.1
Data on file, Abbott Laboratories.Data on file, Abbott Laboratories.
Sibutramine (n=1,898) Control (n=1,521)
30
25
20
15
10
5
0
Pat
ient
s (%
)
No > 0 – < 5 5 – < 10 10 – < 1515 – < 2020 – < 2525 – < 3030 – < 3535 – < 40 > 40increase
SBP or DBP increase (mmHg)
Maximum BP Changes vs. Baseline
Adapted from Sharma AM et al. NAASO 2003.
Post hoc analysis of 21 randomized placebo controlled trials of ≥ 12 weeks duration3419 overweight and obese patients with normal or controlled blood pressure
Sibutramine 10-15 mg n=1898; placebo n= 1521
STORM: Change in Vital Signs
James WPT et al. Lancet. 2000;356:2119.
Baseline to 24 Months in Sibutramine Treatment Group
Mean Change
Sibutramine Placebo
BP, mm HG
Systolic 0.1 - 4.7
Diastolic 2.3 - 1.6
Pulse rate (bpm) 4.1 - 1.9
In STORM most subjects reached 20 mg per study design
Blood Pressure is Lowered with Weight Loss Using Sibutramine
-5
-4
-3
-2
-1
0
1
2
3
< 5% weight loss > 5% weight loss > 10% weight loss
Placebo (n = 2255) Sibutramine (n = 4536)
Adapted from Sharma AM, Int J Obes Relat Metab Disord 2001;25 (Suppl 4): S20-S23.Adapted from Sharma AM, Int J Obes Relat Metab Disord 2001;25 (Suppl 4): S20-S23.
Although weight loss with sibutramine was not associated with equivalent BP reductions as placebo, a greater proportion of sibutramine treated patients achieved weight loss.
Ch
ang
e in
SB
P (
mm
Hg
)
78% 47%
22% 53% 6% 23%
% of treatment group
The Reality of Sibutramine’s BP Effects
• Mean BP changes in recommended dose range is ~ 1 mm Hg increase
• A few, < 5%, have unacceptable blood pressure increases while on sibutramine
• Significant weight loss, > 5%, is associated with mean BP decrease on sibutramine
• BP effects of sibutramine are blocked by beta blockers1
• BP effects of sibutramine are blocked by exercise program2
• In addition to peripheral effects, sibutramine may have central “clonidine-like” sympatholytic effects1
1. Birkenfeld AL et al. Circulation 2002;106: 2459-24652. Berube-Parent S et al. IJO 2001;25: 1144-1153
Tips for Managing Patients on Sibutramine
• Start at 10 mg once daily• Prescribe a sensible diet –
– Meal replacements for two meals and two snacks + one sensible meal per day
– Portion controlled diet with at least three meals per day
• Follow –up: – 4 pounds weight loss in first 4 weeks helps predict success– Monitor blood pressure. Use clinical judgement about
continuing
• Increase dose to increase weight loss, provided BP is well controlled. Decrease dose or discontinue for BP concerns
• Stay within recommended dose range of 5 to 15 mg • Encourage long term use
Antiobesity Drugs Approved for Long-Term Use: How They Work
Sibutramine Orlistat
• FDA approved 1997
• Induces feeling of satiety– Less preoccupation, feeling
satisfied with less food
– Greater control of food
intake
– Need to monitor BP early in
program
• Once daily with or without
food
• FDA approved 1999
• Reduces absorption of
~30% dietary fat– Fat in diet passes
undigested
– Facilitates weight loss
– GI side effects
• 3 times daily with meals
and a vitamin supplement
recommended
Lipase
Mucosal Cell
TG
FAMG
MicelleBile Acids
Intestinal Lumen
Orlistat
Orlistat Prevents Fat Digestion by Binding to Gastrointestinal Lipases
LipaseLipase
TG=triglyceride; MG=monoglyceride; FA=fatty acid
Orlistat: Key Facts• Multiple large clinical trials demonstrating
− Weight loss occurs for 6 months− Efficacy in weight loss maintenance demonstrated
≥ 4 years − Weight loss produces benefits in glycemic control,
lipids, waist circumference, BP− Trials in persons with diabetes and hypertension− Independent action on LDL cholesterol
• Favorable side effect profile − No abuse potential− No valvulopathy, no PPH
• Cautions− Vitamin supplement required for long term use− May interfere with cyclosporin absorption
• Likely to be available over the counter in 2006
36.4
15.4
51.6
27.3
0
10
20
30
40
50
60
% o
f Pat
ient
s
> 5% > 10%% of Weight Lost
Placebo + diet
Orlistat + diet
Meta-analysis of data derived from 4 clinical trials
Xenical® [package insert]. Nutley, NJ: Roche Laboratories, 1999.
Orlistat: 2-Year Efficacy
Effect of Long-Term Treatment With Orlistat (The XENDOS Study)
-4.1 kg
-6.9 kg
0 52 104 156 208-12
-9
-6
-3
0Placebo + lifestyle(n=557)
Orlistat + lifestyle(n=853)
Week
Wei
gh
t ch
ang
e (k
g)
p < 0.001 vs placeboTorgerson JS et al, Diabetes Care 2004; 27(1): 155-61.
Completers Data
Independent Effect of Orlistat on Plasma LDL-Cholesterol
Segal et al. FASEB J 1999;13:A873. Data pooled from 5 trials (N=1773)
0 – 5 5 – 10 10 – 15 > 15
Cha
nge
in P
lasm
a LD
L-C
hole
ster
ol C
once
ntra
tion
(mm
ol/L
)
Weight Loss Category (% initial body weight)
-0.3
0.0
-0.5
-0.4
-0.2
-0.1
-0.6
-0.8
-1.0
-0.9
-0.7
*
**
*
OrlistatPlacebo
*P < 0.01 vs placebo
Orlistat: Effect on Lipids and Waist Circumference
9.3
1.34
12.8
2.9
1
3
5
7
9
11
13
15
HDL-C TG
-2.6
-1.6
-3
-2.5
-2
-1.5
-1
-0.5
0
Waist Circumference
Xenical® [package insert]. Nutley, NJ: Roche Laboratories, 1999.
Orlistat 120 mg TID Placebo
Cha
nge
(in)
% C
hang
e
Orlistat: Effect on Blood Pressure in At-Risk Patients
-12
-10
-8
-6
-4
-2
0
-9
-8
-7
-6
-5
-4
-3
-2
-1
0
Orlistat + diet
Placebo + diet
Systolic (ISH, SBP 140 mm
Hg)
Diastolic (DBP 90 mm Hg)
Data on File (Ref 038-001).
mm Hg
P = 0.032 P = NS
mm Hg
Orlistat: Safety
Sjöström L et al. Lancet. 1998;352:167.
• There is concern about fat-soluble vitamin absorption
Adverse Events (AEs) at 1 Year
0%
3%1%
7%5%
7%
10%
18%20%
31%
0
5
10
15
20
25
30
35
Fatty/Oily Stool IncreasedDefecation
Oily Spotting Fecal Urgency FecalIncontinence
%
Placebo, n = 340Orlistat, n = 343
Tips for Managing Patients on Orlistat
• Discuss potential bowel effects and mechanism with patient
• Start at 120 mg before each meal• Prescribe a moderate fat diet –
– Caution patients about high fat meal or snack
• Metamucil has been shown to reduce bowel effects• For long term use, prescribe a multivitamin• Orlistat can interfere with cyclosporin absorption• Encourage long term use.
Obesity Pharmacotherapy Outline
• How to apply drug trial data to clinical practice• Principles of obesity medication use in clinical practice• Medications approved for long-term use
– sibutramine (Meridia)– orlistat (Xenical)
• Medications approved for short term use– phentermine– others rarely used: mazindol, diethylpropion
• Medications for use in special patients– the depressed obese patient – bupropion (Wellbutrin) and venlafaxine
(Effexor)– type 2 diabetes – metformin , pramlintide (Symlin), exendin-4
(Exenatide)– patients with neuropsychiatric problems - topiramate (Topamax) and
zonisamide (Zonegran)
• Medications in development
Drugs Approved by FDA for Short Term Use in Treating Obesity
Diethylpropion (1959) Tenuate IV
Phentermine (1959) Adipex-P, Ionamin IV
Benzphetamine* (1960) Didrex III
Phendimetrazine (1959) Bontril III
Methamphetamine Desoxyn II
Mazindol* (1973) Mazanor IV
Generic Name Trade Names DEA Schedule
Physicians’ Desk reference 59th Edition, 2005.
*not listed in PDR, but available
FDA Approved Drugs for Short Term Use
• Use of schedule II or III drugs for weight management is not recommended.
• These agents are sympathomimetic as reflected by the side effect profile (restlessness, insomnia, increase in pulse, increase in blood pressure and others).
• Intermittent use is the only means to abide by prescribing guidelines.
• The medications promote appetite reduction. They should be used with an energy deficit diet.
• Weight loss with these medications averages 5 - 7% above placebo.
0 4 8 12 16 20 24 28 32 36
Wei
ght
loss
(kg
)
Continuous Phentermine
Alternating Phentermine and Placebo
Continuous Placebo
Time in Weeks
0
5
10
15
16
32
0
Weight loss (lbs)
Weight Loss with Continuous and Intermittent Phentermine
Munro JF, et al. Br Med J 1968; 1:352-354.
Obesity Pharmacotherapy Outline
• How to apply drug trial data to clinical practice• Principles of obesity medication use in clinical practice• Medications approved for long-term use
– sibutramine (Meridia)– orlistat (Xenical)
• Medications approved for short term use– phentermine– others rarely used: mazindol, diethylpropion
• Medications for use in special patients– the depressed obese patient – bupropion (Wellbutrin) and venlafaxine
(Effexor)– type 2 diabetes – metformin , pramlintide (Symlin), exendin-4
(Exenatide)– patients with neuropsychiatric problems - topiramate (Topamax) and
zonisamide (Zonegran)
• Medications in development
Medicating the Depressed Obese Patient
• Many antidepressants produce weight gain
• Antidepressants associated with weight loss:– Bupropion (Wellbutrin)1
– Venlafaxine (Effexor)2
• Antidepressant associated with initial weight loss at higher doses, followed by weight regain:– Fluoxetine (Prozac)3
1. Anderson Obes Res 2002:10:633.2. PDR Edition 29, 2005.3. Darga et al, AJCN, 1991.
Treatment with Bupropion
0 10 20 30 40 50-15
-10
-5
0
Placebo
SR 400
SR 300
Weeks of Treatment
We
igh
t lo
ss (
%)
Anderson Obes Res 2002:10:633.
Week number1 3 5 7 9 13 21 29 37 45 5317
Placebo
Fluoxetine
N = 16
N = 14
N = 23
N = 22
We
igh
t Los
s (k
g)
Fluoxetine 60 mg and Weight Loss*
Darga et al, AJCN, 1991.
-16
-14
-12
-10
-8
-6
-4
-2
0
Medicating the Patient with Type 2 Diabetes
• Weight gain is associated with use of thioglitazones, sulfonylureas and insulin.
• Metformin is associated with small amounts of weight loss.
• Pramlintide is associated with weight loss.
Weight Change with Metformin in DPP Trial
-4
-3
-2
-1
0
1
Wei
ght C
hang
e (K
g)
0 6 12 18 24 30 36 42 48
Months in study
Metformin
+
Placebo
DPP NEJM 2002.
Pramlintide
• Pramlintide injection approved by FDA 3/2005.
• Indication: as an adjunct treatment in patients with T1DM or T2DM who use mealtime insulin therapy and have failed to achieve desired glucose control despite optimal insulin therapy, with or without a concurrent sulfonylurea agent and/or metformin.
• Synthetic analog of human amylin, designed to replace reduced amylin secretion that accompanies beta cell.
• Patients in clinical trials used less mealtime insulin and also had a reduction in body weight compared to patients taking insulin alone.
Exenatide
• Exenatide is an incretin mimetic
• Exenatide exhibits many of the same effects as the human incretin hormone GLP-1
– Improve blood sugar
– Weight loss
• The FDA’s action date for exenatide is April 30, 2005
Medicating the Neuropsychiatric Patient
• Many antiepileptics and antipsychotics produce weight gain.
• Two agents are associated with weight loss, topiramate and zonisamide.
• These agents are not approved for weight loss and are associated with substantial tolerability and toxicity issues that make them unacceptable for weight management in primary care.
• When medicating for neuropsychiatric disorders, a favorable weigh profile should be taken into account in choosing a medication.
-10
-9
-8
-7
-6
-5
-4
-3
-2
-1
0
0 2 4 6 8 10 12 14 16 18 20 22 24
Weeks of Treatment
Wei
ght
Loss
(%
)
Placebo
64 mg/d
96 mg/d
192 mg/d
384 mg/d
Weight Loss with Topiramate
Bray et al Obes Res 2003 in press.
Zonisamide versus Placebo
0 2 4 6 8 10 12 14 16 18-8
-6
-4
-2
0
Placebo
Zonisamide
Week
Wei
ght
loss
(kg
)
Gadde IJO 2002 (Abs).
Medications Noted in ACP 2005 Pharmacotherapy Guidelines
Data Source
Weight Loss Period for
Weight Change
Mean Weight Change 95% CI
Sibutramine 29 RCTs 52 weeks 4.45 kg (5.29 - 3.62 kg)
Orlistat 22 RCTs 52 weeks 2.75 kg (3.31 - 2.20 kg)
Phentermine 9 RCTs 2 - 24 weeks 3.6 kg (6.0 - 0.6 kg)
Diethylpropion 13 RCTs 6 -52 weeks 3.0 kg (11.5 - 1.6 kg)
Bupropion 3 RCTs 24 - 52 weeks 2.77 kg (4.5 - 1.0 kg)
Fluoxetine 9 RCTs 52 weeks --Range -14.5 to
+0.4 kg
Annals Internal Medicine 2005;142:523-546.
Obesity Pharmacotherapy Outline
• How to apply drug trial data to clinical practice• Principles of obesity medication use in clinical practice• Medications approved for long-term use
– sibutramine (Meridia)– orlistat (Xenical)
• Medications approved for short term use– phentermine– others rarely used: mazindol, diethylpropion
• Medications for use in special patients– the depressed obese patient – bupropion (Wellbutrin) and venlafaxine
(Effexor)– type 2 diabetes – metformin , pramlintide (Symlin), exendin-4
(Exenatide)– patients with neuropsychiatric problems - topiramate (Topamax) and
zonisamide (Zonegran)
• Medications in development
Van Gaal et al. Lancet 2005;365:1389-97.
Rimonabant Weight Loss and Waist Change over 1 year
• Mean weight loss 4.8 kg greater than placebo
• Improvements in HDL, TG, Insulin and HOMA-IR greater than with weight loss alone
• Side effect profile favorable
Van Gaal et al. Lancet 2005;365:1389-97.
Obesity Pharmacotherapy: What Does the Future Hold?
• Epidemic of obesity and comorbidities is unabated.
• Understanding of biology underlying obesity continues to expand.
• New drugs are coming on market – rimonabant 2006.
• Look AHEAD, SOS are evaluating mortality benefit of weight loss.
• Obesity pharmacotherapy is gaining legitimacy.
• Medicating for obesity will follow the paradigm of other chronic diseases (HTN, DM).
• Medications for obesity will not cure obesity.
• Weight loss of 5-10% will be seen with new medications.
• Lifestyle will remain a cornerstone of medicating.
Obesity Pharmacotherapy: What Does the Future Hold?