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Early weight loss with liraglutide predicts long-term success
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Adults who achieve at least 5% weight loss after 16 weeks of liraglutide therapy are more likely to achieve greater than 10% weight loss at 1 year than those with less early weight reduction, according to study findings presented at the World Diabetes Congress.
Matthias Blüher, MD, professor of molecular endocrinology at University Hospital Leipzig, Germany, and colleagues analyzed weight loss, safety and efficacy data from two separate SCALE trials. In the SCALE Obesity and Prediabetes trial, researchers analyzed data from 2,487 adults with overweight or obesity but without diabetes (mean age, 45 years; 79% women; mean BMI, 38.3 kg/m²; 61.4% with prediabetes) randomly assigned once-daily subcutaneous liraglutide 3 mg (Novo Nordisk) or matching placebo for 56 weeks, in addition to maintaining a 500-kcal/day deficit diet and performing at least 150 minutes per week of physical activity.
Matthias Blüher
In the SCALE Diabetes trial, researchers analyzed data from 423 adults with overweight or obesity and type 2 diabetes who were taking one to three oral diabetes medications (mean age, 55 years; 48% women; mean BMI, 37.1 kg/m²) randomly assigned either 3-mg daily liraglutide, 1.8-mg daily liraglutide or placebo in addition to lifestyle interventions for 56 weeks. Researchers estimated mean weight loss and categorical weight loss, as well as safety and efficacy data in both trials.
In the SCALE Obesity and Prediabetes trial, 67.5% of participants achieved at least 5% weight loss by week 16 (early responders); observed mean weight loss was greater at 56 weeks for early responders vs. early nonresponders (11.5% vs. 3.8%). In the SCALE Diabetes trial, 50.4% of participants were classified as early responders and achieved greater mean weight loss at 56 weeks vs. early nonresponders (9.3% vs. 3.6%).
Pooled data from both trials predicted that 93.4% of early nonresponders will not achieve weight loss of 10% or more at 1 year, the researchers wrote.
“People with obesity, but without diabetes, who have an early response to liraglutide 3 mg are very likely to maintain that weight loss after one year (more than 80%), have a very good chance (around 50%) of achieving 10% weight loss and nearly a quarter will achieve a 15% weight loss,” John Wilding, DM, FRCP, professor of medicine and honorary consultant physician at the Clinical Sciences Center, University Hospital Aintree, Liverpool, U.K., told Endocrine Today. “Similar responses (but slightly less weight loss) are seen in people with diabetes. This allows physicians to tell patients that they can have a trial of treatment and if the response is good, they are likely to continue to do well.”
John Wilding
Early responders in both trials also saw greater improvements in cardiometabolic risk factors vs. early nonresponders, with the exception of diastolic blood pressure and LDL cholesterol in the SCALE Diabetes trial. Adverse events were comparable between early responders and early nonresponders, although rates of hepatobiliary disorders in adults without type 2 diabetes were higher in early responders vs. early nonresponders (3.5% vs. 2.1%)
“Patients with obesity and an indication to lose weight should be treated with liraglutide 3.0 mg for an initial 16 weeks,” Bluher told Endocrine Today. “Only those patients who achieve a [greater than] 5% weight loss should then continue with the treatment. Patients who do not meet the 5% weight loss cut-off should stop the liraglutide treatment to avoid unnecessary side effects and health care costs.”– by Regina Schaffer
Reference:
Blüher M, et al. Abstract #1503. Presented at: World Diabetes Congress; Nov. 30-Dec. 4; Vancouver, British Columbia.
Discl osure: The researchers report no relevant financial disclosures.
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Jessica Unick, PhD
Common weight loss practices include weight loss medication, changes in diet and exercise, and sometimes a combination of both. However, with an increased interest in personalized medicine, or tailoring medical decisions and treatments to each individual patient, we need to begin to understand why some people respond to certain forms of treatment while others do not. Similarly, how should we proceed when someone is not initially successful in their weight loss attempt? These study findings are clinically relevant, suggesting that for both those with and without diabetes, if liraglutide therapy and lifestyle treatment produce poor weight losses within the first few months, long-term weight-loss success is highly unlikely. To me this indicates that if a particular weight-loss approach does not initially work for a given individual, the clinician and patient should consider revising the treatment plan to better assist that patient in achieving his or her weight loss goals.
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