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Clinical Research

Effectiveness of anti-obesity medications approved for long-term use in a multidisciplinary weight management program: a multi-center clinical experience

International Journal of Obesity volume 46, pages 555–563 (2022)Cite this article

Subjects

Abstract

Background and aims

Randomized clinical trials have proven the efficacy and safety of Food and Drug Administration (FDA) approved anti-obesity medications (AOMs) for long-term use. It is unclear whether these outcomes can be replicated in real-world clinical practice where clinical complexities arise. The aim of this study was to evaluate the effectiveness and side effects of these medications in real-world multidisciplinary clinical practice settings.

Methods

We reviewed the electronic medical records (EMR) of patients with obesity who were prescribed an FDA-approved AOM for long-term use in academic and community multidisciplinary weight loss programs between January 2016 and January 2020.

Intervention

We assessed percentage total body weight loss (%TBWL), metabolic outcomes, and side effect profile up to 24 months after AOM initiation.

Results

The full cohort consisted of 304 patients (76% women, 95.2% White, median age of 50 years old [IQR, 39–58]). The median follow-up time was 9.1 months [IQR, 4.2–14.1] with a median number of 3 visits [IQR, 2–4]. The most prescribed medication was phentermine/topiramate extended-release (ER) (51%), followed by liraglutide (26.3%), bupropion/naltrexone sustained-release (SR) (16.5%), and lorcaserin (6.2%). %TBWL was 5.0%, 6.8%, 9.3%, 10.3%, and 10.5% at 3, 6, 12, 18, and 24 months. 60.2% of the entire cohort achieved at least 5% TBWL. Overall, phentermine/topiramate-ER had the most robust weight loss response during follow-up, with the highest %TBWL at 12 months of 12.0%. Adverse events were reported in 22.4% of patients. Only 9% of patients discontinued the medication due to side effects.

Conclusions

AOMs resulted in significant long-term weight loss, that was comparable to outcomes previously reported in clinical trials.

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Fig. 1: Follow-up flowchart.
Fig. 2: Weight loss outcomes after anti-obesity medication initiation.

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Acknowledgements

We would like to thank Dr. Michael Jensen for his critical feedback on the reporting of the findings and the discussion.

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Author notes

  1. These authors contributed equally: Gerardo Calderon, Daniel Gonzalez-Izundegui, Kuangda L. Shan.

Authors and Affiliations

  1. Precision Medicine for Obesity Program, Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Rochester, MN, USA

    Gerardo Calderon, Daniel Gonzalez-Izundegui, Oscar A. Garcia-Valencia, Lizeth Cifuentes, Alejandro Campos, Mayank Sharma, Michael Camilleri, Barham K. Abu Dayyeh, Maria D. Hurtado Andrade & Andres Acosta

  2. Division of Gastroenterology and Hepatology, Department of Internal Medicine, and Fraternal Order of Eagles Diabetes Research Center, University of Iowa Carver College of Medicine, Iowa City, IA, USA

    Kuangda L. Shan & Mohamad A. Mokadem

  3. Division of Endocrinology, Diabetes, Metabolism & Nutrition, Mayo Clinic, Rochester, MN, USA

    Maria L. Collazo-Clavell, Meera Shah, Daniel L. Hurley, Haitham S. Abu Lebdeh, Kristine Schmitz, Matthew M. Clark, Karen Grothe & Manpreet S. Mundi

  4. Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA

    Matthew M. Clark & Karen Grothe

  5. Division of Endocrinology, Diabetes, Metabolism & Nutrition, Mayo Clinic Health System, La Crosse, WI, USA

    Maria D. Hurtado Andrade

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Contributions

GC, DGI, KLS, AA, and MAM conceived and design the study. MCC, MS, DH, HAL, KS, MMC, KG, MSM, MC, BAD, MDH, AA, and M.A.M coordinated data contributions. GC, DGI, KLS, OGV, AC, LC, AA, MeS, MaS, MDH analyzed the data. LC, AC, AA, and MDH produced the figures and tables. All authors contributed to the revision of the first draft, reviewed and approved the final version of the paper.

Corresponding authors

Correspondence to Maria D. Hurtado Andrade, Mohamad A. Mokadem or Andres Acosta.

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Competing interests

MSM has research grants from Fresenius Kabi, Nestle, Realfood Blends, and VectivBio and is a consultant for Baxter. AA reports other from Gila Therapeutics, other from Phenomix Sciences, personal fees from Rhythm Pharmaceuticals, personal fees from General Mills, outside the submitted work. BAD has served as a consultant for Boston Scientific, Metamodix, BFKW, DyaMx, and USGI Medical, has received research support for Boston Scientific, Apollo Endosurgery, USGI, Spatz Medical, GI Dynamics, Caim Diagnostics, Aspire Bariatrics, and Medtronic, and has been a speaker for Johnson & Johnson, Endogastric Solutions, and Olympus. MC is a stockholder in Phenomix Sciences and Enterin and serves as a consultant to Takeda, Allergan, Rhythm, Kallyope, and Arena with compensation to his employer, Mayo Clinic. Other authors declare no conflict of interest.

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Calderon, G., Gonzalez-Izundegui, D., Shan, K.L. et al. Effectiveness of anti-obesity medications approved for long-term use in a multidisciplinary weight management program: a multi-center clinical experience. Int J Obes 46, 555–563 (2022). https://doi.org/10.1038/s41366-021-01019-6

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