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Item #11
Long-Term
Pharmacotherapy for Obesity Brings Small Overall Weight Loss
Orlistat
or sibutramines effectiveness over time averages less then 5% wt. loss
Long-term
treatment with orlistat or sibutramine results in weight loss
averaging less than 5% of body weight, according to research presented
at the 2003 Annual Meeting of the Society for Clinical Pharmacology
and Therapeutics.
Dr.
Raj Padwal from University of Toronto, Ontario, Canada and colleagues
undertook a systematic review to examine the effectiveness and safety
of orlistat and sibutramine for long-term promotion of weight loss.
In
8 controlled trials lasting 12 months or more, orlistat produced a
mean incremental weight loss (compared with placebo) of 2.7 kg, the
investigators report, or 2.9% of the initial body weight.
Similarly,
in 3 controlled trials, sibutramine provided a 4.3-kg (or 4.6% of
baseline body weight) greater weight loss than did placebo after a
year of treatment.
With
both drugs, the percentage of patients achieving < 10% better
weight loss than achieved with placebo was small, the researchers
indicate--3% with orlistat and 15% with sibutramine.
High
attrition rates (33% in the orlistat studies and 48% in the
sibutramine studies) hampered the study quality for both agents, the
results indicate.
Dr.
Padwal stated that GI side effects were more common with orlistat
treatment, whereas sibutramine use was associated with small but
significant increases in systolic blood pressure (mean increase, 0.8
mm Hg) and diastolic blood pressure (2.2 mm Hg). "This is of
special concern," he said, "because we would expect blood
pressure to fall with weight loss and because increased blood pressure
is what you would hope to avoid as another cardiovascular risk
factor."
Dr.
Padwal said that, given the choice, "I would favor orlistat over
sibutramine because of the side effect profiles. But neither treatment
provides impressive weight loss."
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DO
YOU KNOW
Studies
have shown that A1c levels are directly linked to healthcare costs.
Every successive 1% rise in A1c above 6 % was associated with
an increase in medical costs of 4% (A1c of 7%), 10% (A1c of 8%) and
30% (A1c of 10%). Yet,
with proper care and treatment, complications and associated medical
costs can be reduced. Even
a 1% decrease in A1c may be associated with a reduction in fatal and
nonfatal heart attacks by 18%.
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