Effectiveness of pharmacological interventions for managing obesity in children and adolescents: A systematic review and meta‐analysis framed using minimal important difference estimates based on GRADE guidance to inform a clinical practice guideline
Authors' conclusion
Few studies examined the impact of pharmacotherapy on PROMs. There is evidence that metformin and GLP1RAs lead to important improvements in cardiometabolic and anthropometric outcomes while accompanied by mild to moderate AEs. Long-term effectiveness and safety of GLP1RAs remain to be evaluated.
Study context
- Population
- <18-year-olds with obesity in randomized controlled trials (RCTs) of pharmacotherapeutic agents published up to November 2022; intervention duration 3–24 months35 RCTs
- Participants
- 26 / 7 / 2
- Comparison
- Pharmacotherapy for paediatric obesity
- Metforminn = 26
- GLP1RAsn = 7
- Orlistatn = 2
- Outcome
- PROMs, cardiometabolic risk factors, anthropometry
Methodological detailsGRADE certainty of evidence, effects framed relative to minimal important differences
- GRADE certainty of evidence
- Effects framed relative to minimal important differences
Pooled result
As reported in the abstract
- Metformin: little to no benefit on patient/proxy-reported outcome measures (PROMs) (e.g., HRQoL; 6 RCTs), moderate reductions in TG, moderate decline in insulin resistance, small to moderate decline in BMIz
- GLP1RAs: response heterogeneous; subgroup analysis demonstrated variability of impact
- Liraglutide (2 RCTs): small reduction in HOMA-IR and BMIz; little to no benefit on other outcomes
- Exenatide (4 RCTs): moderate reduction on blood pressure, small decrease in BMIz; little to no benefit on other outcomes
- Semaglutide (1 RCT): small benefit on HRQoL, small reduction on SBP, moderate reduction on total cholesterol and LDL-C, large reduction on TG, very large decline in BMIz
- Orlistat: moderate reduction in DBP; little to no benefit in other outcomes
Safety
Adverse events
- Metformin: moderate increase in mild to moderate gastrointestinal AEs
- Semaglutide: small increase in mild to moderate gastrointestinal AEs
- Orlistat: very large increased risk of mild to moderate gastrointestinal AEs
- Serious AEs were rare and, where AE reporting was sufficient, considered not likely attributable to the interventions
Original publication
Effectiveness of pharmacological interventions for managing obesity in children and adolescents: A systematic review and meta‐analysis framed using minimal important difference estimates based on GRADE guidance to inform a clinical practice guideline. Pediatr Obes. Published 6 September 2024. doi:10.
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