A study in a real-world setting found that 3 mg liraglutide is associated with the best weight loss and persistence outcomes compared with lorcaserin and orlistat among patients with obesity. These findings were published in Family Practice.
This was a historical population-based cohort study using patient records from Clalit Health Services in Israel. Patients included in the study were adults (N=5306) aged 20 years or older who began anti-obesity treatment between 2018 and 2020 and received at least 2 monthly medication claims during the study period.
The study population comprised patients with a mean age of 47.8 (SD, 12.7) years, 77.8% were women, BMI at baseline was 34 (SD, 18.6), hemoglobin A1C (HbA1C) was 5.78% (SD, 0.8%), 45.3% had hyperlipidemia, 22.8% had hypertension, and 38.4% smoked cigarettes.
The patients received lorcaserin (n=2759), liraglutide (n=1498), or orlistat (n=1049). Stratified by treatment, the groups differed on the basis of age, gender, socioeconomic status, BMI, weight, HbA1C, and history of nonalcoholic fatty liver disease (all P <.001).
Both the liraglutide and lorcaserin cohorts reported significant weight loss at 3, 6, and 9 months (all P <.001) with greater weight loss observed at 9 months among the liraglutide cohort (mean difference, -5.95 vs -1.43 kg), respectively. No significant change in weight was observed among orlistat recipients.
The proportion of patients who lost 10% or more of their body weight by 9 months was highest for liraglutide (31.3%), followed by lorcaserin (11.7%) and orlistat (6.0%).
Compared with orlistat, liraglutide (odds ratio [OR] range, 2.6-7.4; P <.001) and lorcaserin (OR range, 1.9-2; P <.001) were associated with an increased likelihood of losing 10% or more of body weight at follow-up.
Liraglutide was also associated with changes to diastolic blood pressure at 3 months (P =.01), HbA1C at 3 (P =0) and 6 (P =.003) months, low-density lipoprotein cholesterol at 3 months (P =.002), and triglycerides at 3 months (P =.009).
At 6 months, persistence was highest among the liraglutide group (51%), followed by lorcaserin (43%) and orlistat (38%; P <.001).
In a post-hoc analysis that quantified efficacy dependent on persistence, the average weight change at 9 months was higher among patients who continued to take medication after 6 months than those who did not.
The major limitation of this study is the low persistence rates.
“In this study, liraglutide 3 mg was the primary medication associated with clinically significant weight loss and had the highest persistence rate,” the researchers wrote.
Leventhal-Perek S, Shani M, Schonmann Y. Effectiveness and persistence of anti-obesity medications (liraglutide 3 mg, lorcaserin, and orlistat) in a real-world primary care setting. Fam Pract. Published online December 8, 2022. fampra/cmac141
This article originally appeared on The Cardiology Advisor