Pharmacotherapy for adults with overweight and obesity: a systematic review and network meta-analysis of randomised controlled trials
Authors' conclusion
In adults with overweight and obesity, phentermine-topiramate and GLP-1 receptor agonists proved the best drugs in reducing weight; of the GLP-1 agonists, semaglutide might be the most effective.
Study context
- Population
- Adults with overweight and obesity; RCTs of weight-lowering drugs from PubMed, Embase and CENTRAL to March 23, 2021
- Participants
- 48,209 adults132 trials
- Comparison
- Weight-lowering drugs vs lifestyle modification alone
- Outcome
- ≥5% weight reduction (OR) and percentage bodyweight change (MD)
Methodological detailsfrequentist random-effect network meta-analyses, GRADE certainty rating
- Frequentist random-effect network meta-analyses
- GRADE certainty rating
Pooled result
As reported in the abstract
Each group vs lifestyle modificationOR of ≥5% weight reduction (95% CI)
Phentermine-topiramatemost effective; high to moderate certainty
8.02(5.24–12.27)
GLP-1 RA
6.33(5.00–8.00)
Each group vs lifestyle modificationMD of percentage bodyweight change (95% CI)
Phentermine-topiramate
−7.98(−9.27 to −6.69)
GLP-1 RA
−5.79(−6.34 to −5.25)
Further pooled results
| Outcome | OR of weight loss ≥5% (95% CI) | |
|---|---|---|
| Semaglutide: weight loss ≥5% and percentage bodyweight changeSemaglutidevs Lifestyle modificationPost-hoc analysis | 9.82 (7.09–13.61) | |
| 0.050.21520OR of weight loss ≥5% (log scale) |
| Outcome | MD of percentage bodyweight change (95% CI) | |
|---|---|---|
| Semaglutide: weight loss ≥5% and percentage bodyweight changeSemaglutidevs Lifestyle modificationPost-hoc analysis | −11.40 (−12.51 to −10.29) | |
| −20−10010Difference (linear scale) |
Semaglutide: weight loss ≥5% and percentage bodyweight change
- Semaglutide showed substantially larger benefits than other drugs with a similar risk of adverse events
Safety
| Outcome | OR (95% CI) | |
|---|---|---|
| Adverse events leading to drug discontinuationNaltrexone-bupropionvs Lifestyle modification | 2.69 (2.10–3.44) | |
| Adverse events leading to drug discontinuationPhentermine-topiramatevs Lifestyle modification | 2.40 (1.68–3.44) | |
| Adverse events leading to drug discontinuationGLP-1 RAvs Lifestyle modification | 2.22 (1.74–2.84) | |
| Adverse events leading to drug discontinuationOrlistatvs Lifestyle modification | 1.71 (1.42–2.05) | |
| 0.20.5125Odds ratio (log scale) |
Original publication
Pharmacotherapy for adults with overweight and obesity: a systematic review and network meta-analysis of randomised controlled trials. Lancet. Published 6 April 2024. doi:10.
Composed by AI from the published abstract and checked against it. How Briefs are made →