Obesity pharmacotherapy, multidisciplinary weight-loss program effective in ‘real world’ setting

The “real world” use of obesity pharmacotherapy in a multidisciplinary weight-loss program resulted in significant and sustained weight loss comparable to outcomes previously witnessed in clinical trials, according to results of a network meta-analysis presented at the 2018 AGA James W. Freston Conference.

“One of the biggest reasons to do this, was because when clinical trials are done, patients join a strict coaching system where they have to see a nutritionist, and they have to comply with a certain amount of exercise,” Maria Daniela Hurtado, MD, PhD, of the Mayo Clinic in Rochester, Minnesota, told Healio Gastroenterology and Liver Disease. “And unfortunately, that’s not what really happens in real life.”

Hurtado and colleagues conducted a retrospective chart-review of 178 patients (mean age, 47.6 years; mean weight, 117.9 kg; 72% female) with obesity prospectively treated with FDA-approved medications combined with lifestyle interventions for weight management at the Mayo Clinic between January 2016 and January 2018 to assess 1-year outcomes of approved pharmacotherapies outside a clinical setting.

Patients were excluded if they underwent a surgical or endoscopic weight loss intervention, had only one visit, or were treated by providers who prescribed pharmacotherapy to less than 5 patients over the study duration.

Total body weight loss (TBWL) at one year served as the primary endpoint.

Patients were prescribed the combination of phentermine and topiramate ER (34.3%), liraglutide (1.8 mg 17.4% and 3.0 mg 3.4%), topiramate (12.4%), the combination of naltrexone and bupropion SR (11.2%), phentermine (11.2%), lorcaserin (5.6%), and metformin (4.5%)

The TBWL was 4.8 kg at 3 months, 8.4 kg at 6 months, 10.8 kg at 9 months and 12.4 kg at 12 months. At 1 year, the TBWL was 10.3%.

“I think that was one of the most interesting findings,” Hurtado said. “We also demonstrated that even at 3 months, we saw a significant weight loss. It was only at 4%, but even after 3 months of therapy we can already see a significant weight loss. And when we take into account individual medications, we showed pretty much what other studies have shown.”

More than half of patients (65%) lost more than 5% of total body weight, and 44% lost more than 10%.

“Pharmacotherapy to treat obesity can work really well in the real world setting without patients necessarily having to be a part of very intense behavioral programs that sometimes are very costly and time consuming,” she said. – by Ryan McDonald

Reference:

Hurtado MD, et al. Weight Loss Clinical Outcomes to Obesity Pharmacotherapy: ‘Real-world’ experience at the Mayo Clinic. Presented at: 2018 AGA James W. Freston Conference; Arlington, Virginia; Aug. 18-19, 2018.

Disclosure: Hurtado reports no relevant financial disclosures.