As the morbidity and mortality of obesity have significantly increased, most current guidelines recommend pharmacotherapy as the second line of treatment
for this disorder following lifestyle modifications. Pharmacological treatment should be considered as part of
a comprehensive strategy for the treatment of patients
with a BMI ≥30 or ≥27 kg/m2
and an obesity-related comorbidity—HTN, T2DM, dyslipidemia, and sleep apnea.
Additionally, the efficacy of medical treatment should
be evaluated after the first 3 months of drug use. Substantial research has been dedicated to the development
of a newer generation of anti-obesity drugs. In recent
years, many novel agents have undergone phase III
clinical trials. Compared to placebo, these drugs cause
Young Jin Tak and Sang Yeoup Lee: An Updated Review on Anti-Obesity Drugs
www.wjmh.org 217
Table 2. Data from meta-analyses of the anti-obesity drugs approved for long-term use for weight loss
Drug
Study
(duration
≥1 year)
Subject
(drug/placebo)
Lifestyle intervention
(diet/exercise/behavior)
Weighted mean difference
(kg) (95% CI) for the
drug-to-placebo
comparison at 1 year
% weight loss
(drug/placebo)
Odds ratio
(95% CrI) for
achieving
≥5% weight
loss
% of patients with
≥5% weight
loss at 1 year
(drug/placebo)
% of patients with
≥10% weight
loss at 1 year
(drug/placebo)
Odds ratio
(95% CrI) for
discontinuation
due to adverse
event
Orlistat 17 trials 5,572/5,572 Reduced fat intake or
500–800 kcal deficit/
non-specific increase or
30 minutes of moderate
exercise per day/yes or
no
2.60
(2.16–3.04)
4.6/1.7 2.70
(2.34–3.09)
48.8/22.6 17.9/8.8 1.84
(1.53–2.21)
Phentermine/
topiramate
3 trials 1,802/1,735 500 kcal deficit/nonspecific increase/yes 8.80 (7.42–10.2) 8.5/1.7 9.22 (6.63–12.85) 72.0/22.8 49.7/8.6 2.29 (1.71–3.06)
Naltrexone/
bupropion
5 trials 6,963/5,897 500 kcal deficit/nonspecific increase or
30 minutes of moderate
exercise per day/yes
4.95
(3.96–5.94)
6.1/2.1 3.96
(3.03–5.11)
52.4/28.3 28.3/9.7 2.64
(2.10–3.35)
Liraglutide 4 trials 3,096/1,649 500 kcal deficit/minimum
150 minutes of brisk
walking per week/yes
5.27
(4.52–6.06)
7.1/1.7 5.54
(4.16–7.78)
60.3/24.6 30.4/8.4 2.95
(2.11–4.23)
Lorcaserina 4 trials 9,453/9,440 600 kcal deficit/30
minutes of moderate
exercise per day/yes
3.22
(2.46–3.97)
5.1/2.0 3.10
(2.38–4.05)
42.7/19.7 19.0/6.7 1.34
(1.05–1.76)
CI: confidence interval, CrI: credible interval.
aWithdrawn from the market for safety issue related to an increased cancer incidence in February 2020.
https://doi.org/10.5534/wjmh.200010
218 www.wjmh.org
a significant weight reduction, including meaningful
improvements in cardiometabolic profiles, while demonstrating good tolerability and safety in patients with
obesity. Data from most recent meta-analyses showed
that the overall placebo-subtracted weight reduction (%)
with the use of anti-obesity drugs for at least 12 months
ranges from 2.9% to 6.8%; phentermine/topiramate (3
trials, -6.8%) liraglutide (4 trials, -5.4%), naltrexone/bupropion (5 trials; -4.0%), lorcaserin (4 trials; -3.1%), and
orlistat (17 trials, -2.9%) (Table 2) [56,84-88].
Most prior trials conducted on these medications
also performed an intensive consultation on diet and
exercise in not only the placebo but also the treatment
groups. Thus, these medications were proposed for
use as pharmacotherapy in conjunction with healthy
eating, physical activity, and behavior modification.
Further, prior findings demonstrated that anti-obesity
drugs cannot be used as a panacea for the treatment
of obesity; instead, they should be used to facilitate
weight control.
Conflict of Interest
The authors have nothing to disclose.
Author Contribution
Conceptualization: SYL. Investigation: SYL, YJT. Writing –
original draft: YJT. Writing – review & editing: SYL, YJT.
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