Effectiveness of anti-obesity medications approved for long-term use in a multidisciplinary weight management program: a multi-center clinical experience

• Published in: International Journal of Obesity 2022-03, Vol.46 (3), p.555-563
• Main Authors: Calderon, Gerardo, Gonzalez-Izundegui, Daniel, Shan, Kuangda L., Garcia-Valencia, Oscar A., Cifuentes, Lizeth, Campos, Alejandro, Collazo-Clavell, Maria L., Shah, Meera, Hurley, Daniel L., Abu Lebdeh, Haitham S., Sharma, Mayank, Schmitz, Kristine, Clark, Matthew M., Grothe, Karen, Mundi, Manpreet S., Camilleri, Michael, Abu Dayyeh, Barham K., Hurtado Andrade, Maria D., Mokadem, Mohamad A., Acosta, Andres
• Format: Article
• Language: English
• Subjects: 692/308; 692/699/2743/393; Adult; Anti-Obesity Agents - therapeutic use; Body weight; Body weight loss; Bupropion; Clinical medicine; Clinical trials; Controlled release; Electronic health records; Electronic medical records; Epidemiology; FDA approval; Female; Health Promotion and Disease Prevention; Humans; Internal Medicine; Male; Medicine; Medicine & Public Health; Metabolic Diseases; Middle Aged; Naltrexone; Obesity; Obesity - drug therapy; Patients; Phentermine - therapeutic use; Public Health; Side effects; Topiramate; Topiramate - therapeutic use; Weight control; Weight Loss
• ISSN: 0307-0565; 1476-5497
• DOI: 10.1038/s41366-021-01019-6

Background and aims Randomized clinical trials have proven the efficacy and safety of Food and Drug Administration (FDA) approved anti-obesity medications (AOMs) for long-term use. It is unclear whether these outcomes can be replicated in real-world clinical practice where clinical complexities arise. The aim of this study was to evaluate the effectiveness and side effects of these medications in real-world multidisciplinary clinical practice settings. Methods We reviewed the electronic medical records (EMR) of patients with obesity who were prescribed an FDA-approved AOM for long-term use in academic and community multidisciplinary weight loss programs between January 2016 and January 2020. Intervention We assessed percentage total body weight loss (%TBWL), metabolic outcomes, and side effect profile up to 24 months after AOM initiation. Results The full cohort consisted of 304 patients (76% women, 95.2% White, median age of 50 years old [IQR, 39–58]). The median follow-up time was 9.1 months [IQR, 4.2–14.1] with a median number of 3 visits [IQR, 2–4]. The most prescribed medication was phentermine/topiramate extended-release (ER) (51%), followed by liraglutide (26.3%), bupropion/naltrexone sustained-release (SR) (16.5%), and lorcaserin (6.2%). %TBWL was 5.0%, 6.8%, 9.3%, 10.3%, and 10.5% at 3, 6, 12, 18, and 24 months. 60.2% of the entire cohort achieved at least 5% TBWL. Overall, phentermine/topiramate-ER had the most robust weight loss response during follow-up, with the highest %TBWL at 12 months of 12.0%. Adverse events were reported in 22.4% of patients. Only 9% of patients discontinued the medication due to side effects. Conclusions AOMs resulted in significant long-term weight loss, that was comparable to outcomes previously reported in clinical trials.