Pharmacotherapy of obesity: an umbrella review

Abstract

Introduction: lifestyle changes are the cornerstones of obesity treatment. These precede and go along with pharmacological treatment when indicated.

Objectives: to describe the evidence available through systematic reviews (SR) on the efficacy and safety of drugs approved for the treatment of obesity in adults in Argentina.

Materials and methods: searches were carried out in five electronic databases, in Spanish, English and Portuguese, in which SRs with or without meta-analysis were selected, published between January 2015 and March 2021. The quality of the evidence was analyzed through AMSTAR2 tool.

Results: 183 potentially relevant SRs were identified, finally including 7 (6 with meta-analysis). At 12 months of treatment, a range of additional weight loss from medication use vs. placebo: with orlistat from 2.12 to 3.07 kg at a dose of 360 mg/day; with liraglutide from 5.15 to 5.8 kg at a dose of 3 mg; and with naltrexone-bupropion from 2.53 to 4.95 kg at a dose of 32/360 mg or 16/180 mg. Gastrointestinal (GI) symptoms predominated among adverse effects (AEs) in all drugs.

Conclusion: drugs were superior to placebo in relation to weight loss, at 12 months of intervention; however, it is necessary to evaluate the cost benefit of their use and long-term results. Its application in the framework of multicomponent treatments and intensive lifestyle change interventions, considering the eating behavior phenotype, among other influencing factors, would allow optimization of results.