Issue 150 Item 11 Long-Term Pharmacotherapy for Obesity Brings Small Overall Wei

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.” ================================ 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%.