FDA-Approved Pharmacotherapy for Weight Loss Over the Last Decade

Abstract

Obesity is a recently defined illness whose diagnosis and treatment continue to be stigmatized. Currently, due to lifestyle changes brought on by technological advancements and the wide availability and affordability of high-calorie foods, millions of people around the world suffer from obesity and/or its sequelae. Finding adequate prevention and treatment options would therefore lead to massive improvements in the duration and quality of life of affected individuals. In this review, we searched the PubMed database for studies exploring the safety and efficacy of the five medications currently approved by the FDA for the treatment of obesity. We included only studies pertaining to adult patients that have been published between 2012 and 2022. We found evidence that all the drugs analyzed such as orlistat, phentermine/topiramate, naltrexone/bupropion, liraglutide, and semaglutide appear to be effective in inducing weight loss, with the suggestion that semaglutide may have superior efficacy. However, a massive obstacle in developing treatment guidelines remains the lack of prolonged studies monitoring the long-term safety and efficacy of obesity medications. Nevertheless, in patients at risk of complications from obesity, the benefits of losing fat mass may outweigh the potential side effects associated with these medications and clinicians should prescribe whichever of the FDA-approved pharmacotherapy they deem most appropriate for the patient's specific set of circumstances.

Serum uric acid lowering and effects of sodium‐glucose cotransporter‐2 inhibitors on gout: A meta‐analysis and meta‐regression of randomized controlled trials

“…Metformin and thiazolidinediones can reduce endogenous hyperinsulinaemia by directly countering the underlying insulin resistance via cellular actions 34 ; however, their effects on gout appear to lag far behind the effects seen with SGLT2 inhibitors 35 . Glucagon‐like peptide‐1 receptor agonists (GLP‐1RAs), the novel incretin‐based peptides, can reduce insulin resistance in the long term via sustained weight loss through their effects on satiety 36 . However, rapid weight loss is also not desirable and can precipitate attacks of gout 37 .…”

Novel Anti-Obesity Pharmacotherapies

“…Weight loss at a total of 5% or more of baseline weight over a period of 3 months is considered clinically significant as per current studies, though more novel pharmacotherapies have now surpassed these goals [4]. Currently, there are six agents that are FDA approved for weight loss: orlistat, phentermine monotherapy, phentermine-topiramate, liraglutide 3.0 mg, naltrexone-bupropion, and (most recently) semaglutide 2.4 mg [5].…”

Preclinical pharmacokinetics and tolerability of a novel meglumine‐based parenteral solution of topiramate and topiramate combinations for treatment of status epilepticus

“…1,2 In addition, TPM is used for the prevention of migraine, 3 and in combination with the amphetamine derivative phentermine, has been cleared by the U.S. Food and Drug Administration (FDA) for appetite suppression. 4 TPM has activity at multiple molecular targets, 5,6 which may account for why it is effective in both epilepsy and migraine.…”

“…Topiramate (TPM; Figure 1) is a broad‐spectrum antiseizure medication (ASM) with established efficacy as oral monotherapy or adjunctive therapy in the treatment of adult and pediatric patients with partial seizures (with or without generalized seizures), generalized tonic–clonic seizures, and seizures associated with Lennox–Gastaut syndrome 1,2 . In addition, TPM is used for the prevention of migraine, 3 and in combination with the amphetamine derivative phentermine, has been cleared by the U.S. Food and Drug Administration (FDA) for appetite suppression 4 . TPM has activity at multiple molecular targets, 5,6 which may account for why it is effective in both epilepsy and migraine.…”