Dataset Information

Effects of Weight-Loss Medications on Cardiometabolic Risk Profiles: A Systematic Review and Network Meta-analysis.

ABSTRACT:

Background & aims

We performed a systematic review and network meta-analysis to evaluate the overall and comparative effects of weight-loss medications approved by the Food and Drug Administration for long-term use on cardiometabolic risk profiles of obese adults.

Methods

We performed a systematic literature review through February 28, 2017 to identify randomized clinical trials of the effects of Food and Drug Administration-approved weight-loss medications (ie, orlistat, lorcaserin, naltrexone-bupropion, phentermine-topiramate, and liraglutide) administered to obese adults for 1 year or more, compared with placebo or another active agent. Outcomes of interest included changes in blood glucose (fasting blood glucose [FBG] and hemoglobin A1c), cholesterol profile (low-density lipoprotein and high-density lipoproteins), blood pressure (BP; systolic/diastolic), and waist circumference (WC). We performed pair-wise and network meta-analyses with outcomes reported as weighted and standardized mean differences. Quality of evidence was rated using GRADE (Grading of Recommendations Assessment, Development and Evaluation).

Results

In a meta-analysis of 28 randomized controlled trials (29,018 participants; median body mass index, 36.1 kg/m²), we associated weight-loss medications with a modest decrease in FBG (weighted mean difference, 4.0 mg/dL; 95% confidence interval, -4.4 to -3.6 mg/dL) and WC (weighted mean difference, reduction of 3.3 cm; 95% confidence interval, -3.5 to -3.1 cm), without clinically meaningful changes in systolic/diastolic BP or cholesterol profile vs placebo (standardized mean difference <0.2); effects varied among drugs. Phentermine-topiramate use was associated with a substantial decrease in WC and a modest decrease in FBG, hemoglobin A1c, and BP, and had minimal effect on cholesterol. Liraglutide use was associated with a substantial decrease in FBG, hemoglobin A1c, and WC, and a minimal effect on BP and cholesterol. Naltrexone-bupropion use was associated with moderate increase in high-density lipoprotein cholesterol, but had a minimal effect on FBG and WC. Orlistat use was associated with a decrease in low-density lipoprotein and high-density lipoprotein cholesterol. No drug improved all cardiometabolic risk factors.

Conclusions

In a systematic review and network meta-analysis, we found Food and Drug Administration-approved weight-loss medications to have only modest positive effects on cardiometabolic risk profile. Further research is needed to evaluate the long-term cardiometabolic benefits of these medications.

Prospero

CRD42016039486.

SUBMITTER: Khera R

PROVIDER: S-EPMC5880739 | biostudies-literature | 2018 Apr

REPOSITORIES: biostudies-literature

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Publications

Effects of Weight-Loss Medications on Cardiometabolic Risk Profiles: A Systematic Review and Network Meta-analysis.

Khera Rohan R Pandey Ambarish A Chandar Apoorva K AK Murad Mohammad H MH Prokop Larry J LJ Neeland Ian J IJ Berry Jarett D JD Camilleri Michael M Singh Siddharth S

Gastroenterology 20180103 5

<h4>Background & aims</h4>We performed a systematic review and network meta-analysis to evaluate the overall and comparative effects of weight-loss medications approved by the Food and Drug Administration for long-term use on cardiometabolic risk profiles of obese adults.<h4>Methods</h4>We performed a systematic literature review through February 28, 2017 to identify randomized clinical trials of the effects of Food and Drug Administration-approved weight-loss medications (ie, orlistat, lorcaser ...[more]

PMID: 29305933

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Project description:BackgroundObesity is one of the most significant causes of morbidity and mortality worldwide. Current studies suggest a new type of obesity, normal weight obesity (NWO), which is defined as having a normal body mass index (BMI), but a high-fat percentage increases the risk of cardiometabolic risk factors (CMRFs). This systematic review and meta-analysis aimed to pool the association between NWO with CMRFs.MethodsA systematic search of the literature in all available electronic databases, including Scopus, Web of Science, EMBASE, and PubMed, was performed until October 2021. All English studies that assessed the association of NWOs [compared to normal weight non-obese (NWNO)] and the CMRFs were included. Two investigators extracted data and performed a quality assessment. The heterogeneity between studies was assessed with I-squared and Cochran's Q tests. Odds ratio (OR) was used as an effect size to pool the association of NWO with CMRFs.ResultsTwenty-five articles that met the inclusion criteria entered the study. The total number of participants was 177,792, with an age range of 13 to 75 years. Most studies were conducted on the general population (adults) and were from China. The result of fixed-effect model meta-analysis indicated an increased odds of hyperglycemia (OR:1.50, 95%:1.23, 1.76), high TG (OR:1.90, 95% CH:1.44, 2.35), low HDL (OR: 1.28, 95% CI:1.06, 1.49) and diabetes (OR:1.39, 95% CI:1.30, 1.49). Moreover, the random effect meta-analysis showed that NWO increased the odds of dyslipidemia (OR:1.83, 95% CI:1.61, 20.4), HTN (OR:1.40, 95% CI:1.28, 1.51) and metabolic syndrome (OR:1.92, 95% CI:1.58, 2.26). Moreover, the mean of all CMRFs except plasma glucose in NWO subjects was statistically higher than NWNO subjects (p-value<0.05).ConclusionThe present study showed that NWO increased the odds of CMRFs. These findings indicate the inadequacy of the BMI measurement and the need for body fat assessment for a better obesity risk assessment.

Project description:ImportanceThe 2023 American College of Rheumatology and American Association of Hip and Knee Surgeons Clinical Practice Guideline concluded that obesity alone should not delay joint replacement. Therefore, a substantially increased utilization of joint replacement among patients with obesity could be expected. However, patients with obesity are at increased risk of revision, posing unique challenges as the surgery is complex and costly, and it remains unknown whether postoperative weight loss could decrease the risk of revision.ObjectiveTo examine the association of the proportion of postoperative weight loss following antiobesity medication use with the risk of revision among patients with obesity undergoing hip or knee replacement.Design, setting, and participantsUsing a target trial emulation, a causal inference framework, this retrospective cohort study investigated patients with obesity who underwent hip or knee replacement. Data were from the IQVIA Medical Research Database (2000-2023). Statistical analysis was performed from October 2023 to June 2024.Main outcomes and measuresEmulated analyses of a hypothetical target trial were assessed for the association of small-to-moderate (2%-10%) or large (≥10%) weight loss after initiating antiobesity medications (orlistat, sibutramine, glucagon-like peptide-1 receptor agonists, and rimonabant) within 1 year with the risk of 5-year and 10-year revision after initiation of antiobesity medications.ResultsAmong 3691 qualified participants (mean [SD] age, 64.7 [9.3] years; 2322 [62.9%] women), the 5-year risks of revision were 5.6%, 4.4%, and 3.7% for weight gain or stable, small-to-moderate weight loss, and large weight loss groups, respectively. Compared with the weight gain or stable group, the hazard ratios (HRs) were 0.75 (95% CI, 0.55-1.04) for the small-to-moderate weight loss group and 0.57 (95% CI, 0.36-0.91) for the large weight loss group. Similar results were observed when the analyses were performed separately for hip or knee replacement. The HRs for revision were 0.55 (95% CI, 0.32-0.93) for small-to-moderate weight loss and 0.49 (95% CI, 0.25-0.97) for large weight loss groups compared with the weight gain or stable group in patients undergoing knee replacement; the corresponding HRs for revision were 0.82 (95% CI, 0.54-1.25) and 0.53 (95% CI, 0.30-0.93) in patients undergoing hip replacement. Consistent findings were obtained regarding the association of weight loss with the 10-year risks after initiating antiobesity medications.Conclusions and relevanceIn this cohort study using a target trial emulation, a higher proportion of weight loss after initiating antiobesity medications within 1 year was associated with a lower risk of 5-year and 10-year revision among patients with obesity undergoing joint replacement. These results suggest that antiobesity medication use, with relatively safe and sustainable weight loss, may be an effective strategy for improving implant survivorship of hip and knee replacements in the obese population.

Dataset Information

Effects of Weight-Loss Medications on Cardiometabolic Risk Profiles: A Systematic Review and Network Meta-analysis.

Background & aims

Methods

Results

Conclusions

Prospero

Publications

Effects of Weight-Loss Medications on Cardiometabolic Risk Profiles: A Systematic Review and Network Meta-analysis.

Similar Datasets

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