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The uphill battle facing antiobesity drugs

International Journal of Obesity volume 39, pages 377–378 (2015)Cite this article

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Almost 70% of adults in the United States are overweight, and of these, one-third are clinically obese.1 Obesity is associated with mortality and morbidity from a host of conditions ranging from cardiovascular diseases and diabetes to osteoarthritis and cancer.1 The estimated direct cost of obesity totals nearly $200 billion dollars annually.1 Federal, state and local governments have implemented numerous policy strategies to mitigate the impact of the obesogenic environment on individuals.2 However, despite these efforts and decades of research and development, the role of medicines in the routine management of obesity is anything but clear.

Amphetamines and related sympathomimetic drugs, such as diethylproprion (Tenuate), benzphetamine (Didrex), phentermine (Adipex) and phendimetrazine (Bontril), were some of the earliest antiobesity therapies approved by the FDA (Food and Drug Administration). Although use of these drugs is associated with short-term weight loss, their adoption in clinical practice has been limited. Although use of these drugs is associated with short-term weight loss and some physicians may commonly prescribe them, their adoption in clinical practice has been limited. These agents currently capture a trivial amount of the total market for prescription drugs, and of the obesity drugs approved for use in the United States phentermine (Adipex) remains the most frequently prescribed (Table 1). In the 1970’s, these drugs were followed by the approval of a serotoninergic anorectic, fenfluramine, whose adoption was also limited by risks of valvular heart disease and pulmonary hypertension. After a 1992 clinical trial of a fenfluramine and phentermine combination yielded significantly greater weight loss results compared with either drug used alone and fewer fenfluramine-related side effects, the popularity of the combination skyrocketed. However, increasing evidence of the association between serotoninergic anorectics such as ‘fen–phen’ and dexfenfluramine, and valvular heart disease and pulmonary hypertension, led to their market withdrawal several years later.

Table 1 Leading antiobesity medications by treatment class, 2011–2013
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Acknowledgements

GCA is supported by the Agency for Healthcare Research and Quality (RO1 HS0189960) and the National Heart, Lung and Blood Institute (R01HL107345). The funding sources had no role in the design and conduct of the study, analysis or interpretation of the data and preparation or final approval of the manuscript before publication. The statements, findings, conclusions, views and opinions contained and expressed in this article are based in part on data obtained under license from the following IMS Health Incorporated information service(s): National Prescription Audit (2011–2013). The statements, findings, conclusions, views and opinions contained and expressed herein are not necessarily those of IMS Health Incorporated or any of its affiliated or subsidiary entities.

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Authors and Affiliations

  1. Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA

    M Daubresse & G C Alexander

  2. Center for Drug Safety and Effectiveness, Johns Hopkins University, Baltimore, MD, USA

    M Daubresse & G C Alexander

  3. Division of General Internal Medicine, Department of Medicine, Johns Hopkins Medicine, Baltimore, MD, USA

    G C Alexander

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  1. M Daubresse
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  2. G C Alexander
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Correspondence to G C Alexander.

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Competing interests

Dr Alexander is Chair of the FDA’s Peripheral and Central Nervous System Advisory Committee, serves as a paid consultant to IMS Health, and serves on an IMS Health scientific advisory board. This arrangement has been reviewed and approved by Johns Hopkins University in accordance with its conflict of interest policies.

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Daubresse, M., Alexander, G. The uphill battle facing antiobesity drugs. Int J Obes 39, 377–378 (2015). https://doi.org/10.1038/ijo.2014.169

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