Abstract 16413: Association of Weight Loss Medications With Cardiometabolic Risk Factors: Systematic Review and Network Meta-Analysis
Background: The average excess weight loss with FDA-approved weight loss drugs ranges from 2.6 to 8.8 kg. However, their efficacy in improving cardiometabolic risk is not known. We assessed this association in a systematic review and network meta-analysis.
Methods: We included randomized clinical trials (RCTs) of overweight/obese adults comparing ≥1 year therapy with an FDA-approved weight loss drug (orlistat, lorcaserin, naltrexone-bupropion, phentermine-topiramate [PT], liraglutide) with each other or placebo. Outcomes assessed were changes in fasting blood glucose, LDL, HDL, blood pressure (systolic [SBP] and diastolic [DBP]) and waist circumference. We performed pairwise and network meta-analysis using an intention-to-treat approach. Outcomes were reported as weighted and standardized mean difference (WMD, SMD). Magnitude of effect size was compared based on the SMD estimates (small = 0.2; medium = 0.5; large = 0.8).
Results: We identified 28 RCTs with 29018 patients (median age 46 years; BMI 36.1 kg/m2). In pooled analysis, weight loss drugs resulted in a modest decrease in fasting glucose (WMD -4.0 mg/dL; 95% CI -4.4, -3.6; SMD -0.27 [-0.30, -0.24]) and waist circumference (WMD 3.3 cm, 95% CI -3.5, -3.1; SMD -0.36 [-0.38, -0.33]), without meaningful change in SBP, DBP, LDL or HDL (SMD <0.2), over placebo. In placebo-comparisons from the network meta-analysis (Figure), liraglutide (-15.6 mg/dL) and orlistat (-8.0 mg/dL) modestly improved fasting glucose. There were smaller improvements in LDL with orlistat, and SBP with liraglutide and PT (SMD 0.2-0.3). Waist circumference decreased with all drugs, most with PT and liraglutide. Liraglutide led to modest improvements in fasting glucose and waist circumference (SMD 0.2-0.5) over other drugs.
Conclusions: Weight loss drugs have modest favorable effects on cardiometabolic outcomes that vary by drug class. Further research is needed to evaluate the long-term impact of these drugs on cardiometabolic risk.
Author Disclosures: R. Khera: None. A. Pandey: None. A. Chandar: None. M.H. Murad: None. Z. Wang: None. M. Camilleri: Research Grant; Significant; NIH 2R56DK067071-11, NovoNordisk, VIVUS. I. Neeland: None. J. Berry: None. S. Singh: None.
- © 2016 by American Heart Association, Inc.