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Clinical Research

Effect of combined GLP-1 analogue and bupropion/naltrexone on weight loss: a retrospective cohort study

International Journal of Obesity volume 48, pages 1118–1125 (2024)Cite this article

Subjects

Abstract

Objective

Little is known about the effect of a multi-drug weight loss strategy in obesity treatment, particularly combining bupropion/naltrexone and glucagon-like peptide 1 (GLP-1) analogue. The purpose of this study was to evaluate if there are any additive effects of prescribing bupropion/naltrexone on top of GLP-1 analogue as weight loss therapy.

Methods

This was a retrospective cohort study of adult patients with a body mass index (BMI) ≥ 30 kg/m2 prescribed GLP-1 analogue therapy at an obesity specialist clinic in Vancouver, Canada. We compared a 6 and 12-month change in total body weight loss (TBWL) for those receiving monotherapy from the initiation of GLP-1 analogue therapy with those receiving combination therapy from the initiation of bupropion/naltrexone added-on therapy. Patients prescribed combination therapy were stratified into responder (loss of ≥ 5% TBWL) and non-responder (TBWL < 5%) subgroups based on initial response to the GLP-1 analogue alone for any amount of time.

Results

The mean weight loss among patients prescribed GLP-1 analogue monotherapy at 12 months was 11.42 kg, SD 9.95 (9.6% TBWL). There was no significant difference between these two treatment strategies overall (HR 0.88, 95% CI 0.68 to 1.14, p = 0.35). However, when stratified by response to initial GLP analogue therapy, the addition of bupropion/naltrexone was associated with a statistically significant reduction in weight in both the responder (4.3% TBWL (p < 0.01)) and non-responder groups (4.0% TBWL (p < 0.01)).

Conclusions

GLP-1 analogues are an effective treatment for weight loss, and the addition of bupropion/naltrexone is associated with greater weight loss including in patients who are initially non-responsive to GLP-1 analogues.

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Data availability

The datasets generated and/or analysed during the current study are available from the corresponding author on reasonable request.

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Authors and Affiliations

  1. Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada

    James Naude & Priya Suresh

  2. Division of General Internal Medicine, University of British Columbia, Vancouver, BC, Canada

    Ali Zentner, Jesse Bittman & Nadia A. Khan

  3. Center for Advancing Health Outcomes, University of British Columbia, Vancouver, BC, Canada

    Nadia A. Khan

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  1. James Naude
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  5. Nadia A. Khan
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Contributions

NAK, AZ, and JN contributed to the design of the study. JN and PS contributed to data collection and JN, NAK contributed towards analysis. All authors contributed to interpretation of the results, and meaningful contribution to writing and accepting the final manuscript. NAK and JN had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Corresponding author

Correspondence to Nadia A. Khan.

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Competing interests

No funding was obtained for the current study. NAK, JN, and PS declare no conflicts of interest for this study. NAK is a volunteer board member of the International Society of Hypertension. JB received educational grant funding from Bayer; speaker fees from Novo Nordisk, Bausch Health and Astra Zeneca; advisory board of Novo Nordisk, Bausch Health and Bayer Inc. AZ received educational programme grant funding from Novo Nordisk and Bausch Health; speaker fees from Novo Nordisk, Bausch Health and Eli Lilly; past advisory board of Eli Lilly.

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Naude, J., Zentner, A., Suresh, P. et al. Effect of combined GLP-1 analogue and bupropion/naltrexone on weight loss: a retrospective cohort study. Int J Obes 48, 1118–1125 (2024). https://doi.org/10.1038/s41366-024-01526-2

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