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Long-term persistence with orlistat and sibutramine in a population-based cohort



Orlistat and sibutramine are widely prescribed antiobesity agents that are approved for 2 years of continuous use. Previous 1–4-year randomized, placebo-controlled trials of these drugs have reported average weight losses of <5 kg, significant adverse effects and attrition rates of up to 60%. The objective of this study was to determine the long-term persistence with orlistat and sibutramine therapy outside a clinical trial setting.

Design, setting and patients:

Population-based administrative data from British Columbia, Canada, were used to create an inception cohort of orlistat and sibutramine users and determine the 2-year persistence with therapy.

Main outcome measure:

Persistence with therapy at 2 years. Drug discontinuation was defined as the failure to refill a prescription within 120 days. Patients discontinuing therapy were censored at the 60-day mark.


Nearly 17 000 users of orlistat and 3500 users of sibutramine were identified. For both orlistat and sibutramine, 1-year persistence rates were <10% and 2-year persistence rates were 2%.


This population-based, retrospective cohort analysis demonstrated very poor long-term persistence rates with orlistat and sibutramine and discontinuation rates that were much higher than those reported in clinical trials.

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R Padwal originated the idea for this study and wrote the initial draft. All authors contributed to the study design, interpretation of the data, and critical revision of intermediate and final drafts. A Kezouh performed the statistical analysis, with input from other authors. R Padwal had full access to the data in the study and takes responsibility for the integrity of the data and the accuracy of the analysis. The authors thank the Centre for Health Services and Policy Research and the College of Pharmacists of B.C. for providing data. The opinions expressed herein represent the views of the authors and not the agencies that provided data. This project was not supported by any external funding source and was approved by the ethics panel at the University of Alberta.

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Correspondence to R Padwal.

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Note: This paper was presented as an oral presentation at the International Congress of Obesity in Sydney, Australia in September 2006

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Padwal, R., Kezouh, A., Levine, M. et al. Long-term persistence with orlistat and sibutramine in a population-based cohort. Int J Obes 31, 1567–1570 (2007).

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