Persistence of newer anti-obesity medications in a real-world setting

Ganguly, Rahul; Tian, Ye; Kong, Sheldon X.; Hersloev, Malene; Hobbs, Todd; Smolarz, B. Gabriel; Ramasamy, Abhilasha; Haase, Christiane L; Weng, Wayne

doi:10.1016/j.diabres.2018.07.017

Cited by 39 publications

(31 citation statements)

References 28 publications

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“…According to our analysis, fewer AEs and higher effectiveness with liraglutide may explain a better adherence to this drug. Our findings are in line with a recent retrospective analysis of the Truven Health MarketScan claims databases that evaluated real‐world data on persistence with newer WLMs . At 6 months, 41.8% of patients were still on liraglutide 3.0 mg, compared with 15.9% lorcaserin, 18.1% naltrexone/bupropion, and 27.3% phentermine/topiramate.…”

Section: Discussionsupporting

confidence: 88%

Effectiveness and tolerability of orlistat and liraglutide in patients with obesity in a real‐world setting: The XENSOR Study

et al. 2019

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Weight-loss medications (WLMs) may offset the physiological adaptations in appetite and energy expenditure that promote weight regain in patients with obesity after initial weight loss (WL) with lifestyle modification (LSM). 1,2 In essentially all randomised clinical trials (RCTs) of WLMs, the addition of these drugs consistently results in a greater weight reduction than LSM alone. According to clinical guidelines, WLMs should be considered in patients with a BMI ≥30 kg/m 2 or ≥27 kg/m 2 with a weight-related comorbidity when a WL of at least 5% has not been reached after 3-6 months of an LSM programme. 3-5 Until a few years ago, the lipase inhibitor orlistat was the only WLM available in Europe for long-term clinical use.The European Medicines Agency (EMA) approved in 2015 two new drugs: liraglutide 3.0 mg, a glucagon-like peptide-1 (GLP-1) receptor agonist and the combination of the antidepressant bupropion, a dopamine and norepinephrine reuptake inhibitor, with the opioid antagonist naltrexone. In the USA, two other drugs were approved by Summary Aims: To evaluate in a real-world setting the effectiveness of two drugs, orlistat and liraglutide, in patients with overweight or obesity and insufficient weight loss (WL) after a lifestyle modification programme. Methods:Retrospective, observational cohort study comparing clinical outcomes of orlistat 120 mg three times a day and liraglutide (up to 3 mg daily) in adult patients with BMI ≥30 kg/m 2 or ≥27 kg/m 2 with at least a weight-related comorbidity who had failed to lose at least 5% of their weight after 6 months of lifestyle modification.The co-primary end-points, assessed at 3-6 months and at the end of the follow-up, were weight change from baseline, proportion of patients who lost at least 5% of their baseline weight and adjusted differences in WL between both drugs.Results: Five hundred patients, 400 in the group of orlistat (age 47.0, weight 107.8 kg) and 100 in the group of liraglutide (age 51.9 years, weight 105.1 kg), were included.Treatment with both drugs significantly reduced weight, fasting plasma glucose, systolic BP, low-density lipoprotein-cholesterol and alanine transaminase over a median follow-up period of 7 months. WL with liraglutide (−7.7 kg) was significantly greater than that observed with orlistat (−3.3 kg), and more individuals lost at least 5% of their baseline weight with liraglutide (64.7%) than with orlistat (27.4%). Rates of prediabetes significantly decreased with liraglutide in comparison to orlistat. Conclusions:In this real-world study, liraglutide showed a greater effectiveness in WL compared with orlistat and improved several obesity-associated metabolic and cardiovascular risk factors.

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Section: Discussionsupporting

confidence: 88%

Effectiveness and tolerability of orlistat and liraglutide in patients with obesity in a real‐world setting: The XENSOR Study

et al. 2019

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“…However, patients in the present study persisted for longer than has been reported in previous RWE studies; results can be compared with the only other similar study of weight loss medication performed to date in Canada, where 18% of patients persisted with orlistat at 6 months 3 . Comparisons can also be made with recent real‐world studies in different patient populations; in a real‐world USA study of common weight loss medications, 41.8% of patients persisted on liraglutide 3.0 mg at 6 months, while lower rates of persistence were seen with other medications: 27.3% of patients persisted on phentermine/topiramate, 18.1% on naltrexone/bupropion and 15.9% on lorcaserin (all p < 0.001) 2 . In a prospective study of 2092 Arabic patients with obesity treated with liraglutide 3.0 mg in the UAE, 38% ( n = 787) persisted for ≥16 weeks and 16% ( n = 340) persisted for ≥28 weeks 17 .…”

Section: Discussionmentioning

confidence: 99%

“…Compliance with obesity medications is notoriously poor; two real‐world USA database studies revealed that only 1–4% and 6–27% of patients persisted with obesity medication for longer than 1 year 1,2 . To date, only persistence with orlistat has been investigated in Canada, and findings showed that 18% of patients were persistent at 6 months, with discontinuation rates much higher than those reported in clinical trials 3 …”

Section: Introductionmentioning

confidence: 99%

Real‐world persistence with liraglutide 3.0 mg for weight management and the SaxendaCare® patient support program

Wharton¹,

Haase

Kamran³

et al. 2020

Obesity Science & Practice

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Summary Objective Weight management medications can significantly increase patients' chances of achieving a clinically meaningful weight loss if patients persist with treatment. This retrospective observational study of de‐identified medical records of 311 patients is the first real‐world study examining persistence with liraglutide 3.0 mg in Canada, and also investigates associations between the SaxendaCare® patient support program and persistence and weight loss. Methods Overall persistence was assessed, as well as associations of enrollment in SaxendaCare®, persistence and weight loss. Results Overall mean (standard deviation) persistence with liraglutide 3.0 mg was 6.3 (4.1) months, and 67.5% (n = 210) and 53.7% (n = 167) of patients persisted for ≥4 and ≥ 6 months, respectively. Enrollment in SaxendaCare® was associated with significantly longer persistence with liraglutide 3.0 mg and greater weight loss. Patients enrolled in SaxendaCare® (n = 119) persisted for 7.9 (4.0) versus 5.2 (3.8) months for those not enrolled (n = 184) (p < 0.001), and had significantly greater percent weight loss after 6 months regardless of the duration of their persistence (−7.9% vs −5.5% from baseline, p < 0.01). Conclusions These findings suggest that, in clinical settings, persistence with liraglutide 3.0 mg can exceed 6 months, and that enrolling in SaxendaCare® may be associated with comparatively longer persistence and, regardless of persistence, greater weight loss.

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“…For example, although the discontinuation rate for AOM is high today, better coverage and improved efficacy could lead to large increases. In the sensitivity analysis, we increased the discontinuation rate from the base case (30%) to 70% for 10 years and to 40% thereafter . We also analyzed the impact of higher treatment prices ($9,029 vs. $7,525; 20% increase relative to the base case) to capture the sensitivity of results to higher‐priced current and next‐generation AOM.…”

Section: Methodsmentioning

confidence: 99%

The Societal Value of Broader Access to Antiobesity Medications

Kabiri¹,

Ward²,

Ramasamy

et al. 2019

Obesity

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Objective Obesity and its complications place an enormous burden on society. Yet antiobesity medications (AOM) are prescribed to only 2% of the eligible population, even though few individuals can sustain weight loss using other strategies alone. This study estimated the societal value of greater access to AOM. Methods By using a well‐established simulation model (The Health Economics Medical Innovation Simulation), the societal value of AOM for the cohort of Americans aged ≥ 25 years in 2019 was quantified. Four scenarios with differential uptake among the eligible population (15% and 30%) were modeled, with efficacy from current and next‐generation AOM. Societal value was measured as monetized quality of life, productivity gains, and savings in medical spending, subtracting the costs of AOM. Results For the 217 million Americans aged ≥ 25 years, AOM generated $1.2 trillion in lifetime societal value under a conservative scenario (15% annual uptake using currently available AOM). The introduction of next‐generation AOM increased societal value to $1.9 to $2.5 trillion, depending on uptake. Finally, societal value was higher for younger individuals and Black and Hispanic individuals compared with White individuals. Conclusions This study suggests that AOM provide substantial gains to patients and society. Policies promoting broader clinical access to and use of AOM warrant consideration to reach national goals to reduce obesity.

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Persistence of newer anti-obesity medications in a real-world setting

Cited by 39 publications

References 28 publications

Effectiveness and tolerability of orlistat and liraglutide in patients with obesity in a real‐world setting: The XENSOR Study

Effectiveness and tolerability of orlistat and liraglutide in patients with obesity in a real‐world setting: The XENSOR Study

Real‐world persistence with liraglutide 3.0 mg for weight management and the SaxendaCare® patient support program

The Societal Value of Broader Access to Antiobesity Medications

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