Anti-obesity medications for long-term weight management in adults
| Drug (trade name) | Approval year | Main mechanism | Maintenance dose | Study duration (wk) | Mean weight loss (kg, %) |
|---|---|---|---|---|---|
| Orlistat77) (Xenical) | FDA 1999, EMA 1998 | Pancreatic and gastric lipase inhibitor | 120 mg, three times a day | 52 | Drug, 8.8 (8.8); placebo, 5.8 (5.8); difference, 2.6 |
| Phentermine-topiramate81) (Qsymia) | FDA 2012 | NE agonist/GABA agonist, glutamate antagonist | Recommended, 7.5 mg/46 mg; maximum, 15 mg/92 mg | 56 | Drug, 8.1 (7.8) at recommended dose, 10.2 (9.8) at maximum dose; placebo, 1.4 (1.2); difference, 8.8 |
| Naltrexone-bupropion79) (Contrave) | FDA 2014, EMA 2015 | Opioid antagonist/DA and NE reuptake inhibitor | 16 mg/180 mg twice daily | 56 | Drug, 6.2 (6.4); placebo, 1.3 (1.2); difference, 5.0 |
| Liraglutide84) (Saxenda) | FDA 2014 EMA 2015 |
GLP-1 agonist | 3 mg once daily, SC | 56 | Drug, 8.4 (8.0); placebo, 2.8 (2.6); difference, 5.3 |
| Semaglutide88) (Wegovy) | FDA 2021, EMA 2021 | GLP-1 agonist | 2.4 mg once weekly, SC | 68 | Drug, 15.3 (14.9); placebo, 2.6 (2.4); difference, 12.7 |
| Tirzepatide97) | Under consideration by FDA | GIP/GLP-1 dual agonist | 5/10/15 mg once weekly, SC | 72 | Drug, 16.1 (15.0) at 5 mg; 22.2 (19.5) at 10 mg; 23.6 (20.9) at 15 mg; placebo, 2.4 (3.1) |
For each medication, weight-loss data are from a pivotal phase 3 trial submitted to the FDA for drug approval.
FDA, Food and Drug Administration; EMA, European Medicines Agency; NE, norepinephrine; GABA, gamma-aminobutyric acid; DA, dopamine; GLP-1, glucagon-like peptide 1; GIP, glucose-dependent insulinotropic polypeptide; SC, subcutaneous injection; CI, confidence interval.
aData on weight loss difference compared to placebo are from a meta-analysis of studies.76) bEstimated treament difference reported in STEP 1. cEstimated treatment differences relative to placebo in SURMOUNT-1 were reported as percentage points: -11.9 %p (95% CI, -13.4 to -10.4) for the 5-mg dose, -16.4 %p (95% CI, -17.9 to -14.8) for the 10-mg dose, and -17.8 %p (95% CI, -19.3 to -16.3) for the 15-mg dose (P<0.001 for all comparisons).