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Metformin modestly effective, not superior, in childhood obesity
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Metformin provided a modest but statistically significant reduction in BMI and weight when combined with lifestyle interventions, but it was not clinically superior to other options available for treating childhood obesity, according to a JAMA review.
“Our analysis indicated that metformin combined with lifestyle interventions is efficacious in helping obese children aged 10 to 16 years reduce their BMI and weight as compared with lifestyle interventions alone in the short term. However, the magnitude of change was small relative to known reductions needed to impart long-term health benefits,” Marian S. McDonagh, PharmD, of the department of medical informatics and clinical epidemiology at Oregon Health & Science University, and colleagues wrote.
Investigators looked at 14 randomized clinical trials with a total of 946 enrolled children and adolescents aged 10 to 16 years and baseline BMIs from 26 to 41.
Based on 13 of those 14 trials, researchers reported that patients assigned metformin had a greater BMI reduction than those in control groups, although they ranked this evidence as moderate. Further stratification of data by duration of study showed that the largest difference favoring metformin was seen in the seven trials that ended at 6 months (–1.38; 95% CI, –1.93 to –0.82), and one of the studies that continued observation for an additional 48 weeks showed a regression toward baseline.
Subgroup analyses showed that there was a greater reduction of BMI in patients whose baseline BMI was ≥35 (–1.23; 95% CI, –1.66 to –0.79) as opposed to those with baseline BMI <35 (–1.05; 95% CI, –1.81 to –0.29). Children aged 12 years and younger also showed a greater reduction in BMI compared with adolescents (–1.56; 95% CI, –2.29 to –0.84).
Similarly, weight loss at 6 months was greater than that at 1 year, and greater weight loss was seen in patients with BMI ≥35.
“Subgroup analyses suggest that there may be children who benefit more, for example, those with BMI greater than 35, age 12 years or younger, and who have not failed lifestyle interventions previously,” the researchers wrote. “To determine whether there are specific patients who may have a clinical, and not just statistical, benefit from treatment with metformin, a large-scale trial is needed.”
Disclosure: The researchers report no relevant financial disclosures.
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