A Beauty Contest for Obesity Meds in JAMA

A new study published this week in JAMA provides useful perspective on the safety and efficacy of the newer obesity meds now available for managing the chronic disease of obesity. Rohan Khera and colleagues integrated the results for 29,018 patients in 28 published clinical trials and concluded:

Among overweight or obese adults, orlistat [Alli, Xenical], lorcaserin [Belviq], naltrexone-bupropion [Contrave], phentermine-topiramate [Qsymia], and liraglutide [Saxenda], compared with placebo, were each associated with achieving at least 5% weight loss at 52 weeks. Phentermine-topiramate and liraglutide were associated with the highest odds of achieving at least 5% weight loss.

On the safety side of the equation, the drug with the lowest odds of being stopped because of an adverse event was lorcaserin. The chart above, adapted from the study, does a pretty good job of summarizing how these agents fared against each other in this analysis. Drugs further to the right on the chart ranked better for weight outcomes. Drugs closer to the top of the chart ranked better for having few adverse events.

This study is not really some sort of beauty contest with winners and losers. The authors note that obesity care “should be highly individualized” because of individual “differences in efficacy, safety, and response to therapy.” Standardized protocols are simply not yet an option, though principles for delivering a high standard of care are becoming clear.

What’s really noteworthy here is that JAMA is publishing a thoughtful examination of  pharmacotherapy for obesity. Just a little over two years ago, when these drugs were emerging, JAMA Internal Medicine did not take this therapy so seriously. It published a flippant commentary that dismissed some of these same drugs as “slim pickings,” encouraging physicians not to bother with pharmacotherapy for obesity.

Seeing JAMA get serious about obesity care is deeply gratifying.

Click here for the new study and here for more from the LA Times.

Apple Beauty Contest, photograph © quilldancer / flickr

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June 17, 2016