Long-term pharmacotherapy of obesity 2000 - A review of efficacy and safety

To clarify the efficacy of antiobesity drugs, this article reviews all long -term (greater than or equal to 36 weeks), placebo-controlled trials of obe sity pharmacotherapy published since 1960. Since fears of anorexiant-induce d heart valve damage preclude many physicians and patients from even consid ering antiobesity drugs, this area is also reviewed in-depth. Electronic da tabase and manual bibliography search was used to identify all relevant pub lications. While existing studies are too few and heterogeneous to warrant meta-analysis, their review does provide evidence highly relevant to the sa fety and efficacy of available anorexiants. Weight loss attributable to obe sity pharmacotherapy (ie, in excess of placebo) in trials lasting 36 to 52 weeks was 8.1% or 7.9 kg for those receiving phentermine resin, 5.0% or 4.3 kg for those receiving sibutramine hydrochloride, 3.4% or 3.4 kg for those receiving orlistat, and -1.5% or -1.5 kg for those receiving diethylpropio n hydrochloride. Physiologic, pathologic, and epidemiological studies stron gly support that anorexiant-induced valvulopathy is attributable to specifi c serotonergic properties of the fenfluramines that are not present with av ailable weight loss drugs.