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Few eligible patients receive pharmacotherapy for weight loss
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Fewer than 1% of eligible patients with obesity were prescribed weight-loss medication in a primary care setting, and those who were prescribed pharmacotherapy tended to be younger, heavier women, according to recent study findings.
In a retrospective study of electronic prescription records, Shumin Zhang, MD, ScD, senior director of epidemiology and safety statistics at Takeda Development Center Americas Inc. in Deerfield, Illinois, and colleagues analyzed data from 1,835,541 patients with a BMI greater than 30 kg/m² or a BMI between 27 kg/m² and 30 kg/m² with at least one obesity-associated comorbidity, identified through the GE Centricity electronic medical record database. Patients, identified between 2002 and 2011, had at least 12 months of continuous enrollment before and after the first eligible recorded BMI (index date). Weight-loss drugs considered included benzphetamine, diethylpropion, Xenical (orlistat, Hoffmann-La Roche), Alli (orlistat, GlaxoSmithKline), phendimetrazine, phentermine, Meridia (sibutramine, Abbott Laboratories; discontinued), Belviq (lorcaserin, Eisai) and Qsymia (phentermine/topiramate, Vivus). Saxenda (liraglutide, Novo Nordisk) and Contrave (bupropion/naltrexone, Takeda) were not considered in this analysis.
Shumin Zhang
Within the cohort, 55.4% of patients had hypertension; 36.1% had dyslipidemia; 13.4% had type 2 diabetes. Within 12 months of the index date, 0.7% of patients received pharmacotherapy (n = 11,862). Those who received a prescription for weight-loss medication had a higher BMI (median BMI, 33.6 kg/m² vs. 31.3 kg/m²) and were younger (mean age, 42 years vs. 52 years) and primarily women (84.3% vs. 58.2%). Patients prescribed pharmacotherapy were also more likely to be commercially insured (70.1% vs. 50.4%) and more frequently to use antidepressants (30.8% vs. 14.1%) and nonsteroidal anti-inflammatory drugs (21.7% vs. 12%) vs. those who did not at baseline (P < .0001 for all).
The most frequently prescribed weight-loss drug was phentermine (62.9%), followed by orlistat (19.1%) and sibutramine (14.7%).
The use of weight-loss drugs at baseline was rare (0.6%); however, it was the strongest predictor of future weight-loss drug use, according to researchers, with those patients taking a weight-loss drug at baseline 99 times more likely to use weight-loss drugs in the next 12 months.
“Although obesity affects one-third of adult Americans and is associated with high health and economic burden, the utilization of adjunctive pharmacotherapy for weight loss, which has demonstrated health benefits in clinical trials, is considerably low,” Zhang told Endocrine Today. “Research on the understanding of factors influencing obesity management and control is needed.”
The researchers noted that cost may also be a barrier to use, as many health plans in the United States, including the Medicare prescription drug program, do not cover weight loss drugs. – by Regina Schaffer
For more information:
Shumin Zhang, MD, ScD, can be reached at Takeda Development Center Americas, Inc., One Takeda Parkway, Deerfield, Il, 60015; email: Shumin.zhang@takeda.com.
Disclosure: Takeda supported this study. All of the researchers were employees of Takeda when this study was conducted.
Perspective
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Daniel Bessessen, MD
Obesity is one of the most common conditions encountered in clinical practice. Authoritative guidelines uniformly encourage treatment of obesity, and pharmacotherapy has been advocated as an appropriate option for those individuals with a BMI greater than 30 kg/m2, or between 27 and 30 kg/m2 with a weight-related comorbidity, since 1998. Yet this new study by Zhang and colleagues demonstrates what many physicians would guess: That the number of eligible patients receiving this treatment option is surprisingly low. If only 1% of hypertensive patients received a blood pressure-lowering drug, or 1% of diabetic patients received a glucose-lowering drug, I suspect there would be a strong call to action. Yet this is not the case with obesity. There are a lot of obese patients, we are fortunate in having four new FDA-approved medications, yet not much treatment is happening. Is the problem that providers are concerned about safety? Is the main barrier a lack of reimbursement? Is the problem that available medications don’t produce “enough” weight loss? We currently don’t have answers to these questions, but the dramatically low rates of prescribing suggest that perhaps we should work toward finding some.
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