Risk of Gastrointestinal Adverse Events Associated With Glucagon-Like Peptide-1 Receptor Agonists for Weight Loss

Sodhi, Mohit; Rezaeianzadeh, Ramin; Kezouh, Abbas; Etminan, Mahyar

doi:10.1001/jama.2023.19574

Cited by 96 publications

(51 citation statements)

References 6 publications

(7 reference statements)

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“…Phentermine/topiramate might be attractive to those with insufficiently treated migraine headaches, since topiramate is FDA approved for this condition. NuSH-BTs appear to confer an elevated relative risk of serious gastrointestinal complications, including pancreatitis, gastroparesis, and ileus, although absolute risk is low. Therefore, they should be used with caution in patients with a history of these disorders.…”

Section: Adjunctive Aomsmentioning

confidence: 99%

Approach to Obesity Treatment in Primary Care

Yanovski,

Yanovski

2024

JAMA Intern Med

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ImportanceMore than 40% of US adults have obesity, which increases the risks for multiple chronic diseases and premature mortality. Historically, nonsurgical interventions often have not led to sufficient weight loss and maintenance to improve health, but highly effective antiobesity medications (AOMs) have recently become available, and additional effective therapeutics are under development. Given that most medical care for adults with obesity is delivered in primary care settings, guidance for integrating weight-management approaches is needed.ObservationsLifestyle interventions can lead to a mean weight loss of 2% to 9% of initial weight at 1 year and increase the likelihood of weight loss of 5% or more, but weight regain over time is common even with continued treatment. Adjunctive treatments, including AOMs and surgical approaches, can lead to larger, more sustained weight loss and improvements in numerous obesity-associated medical conditions. Highly effective AOMs, including nutrient-stimulated hormone-based therapies, induce mean weight loss of 15% or more. Barriers to intervention, including access to care, have a disproportionate influence on populations most affected by obesity and its consequences.Conclusions and RelevancePrimary care clinicians play a vital role in the assessment, management, and support of patients with obesity. With careful clinical assessment and shared decision-making, a flexible treatment plan can be developed that reflects evidence of treatment efficacy, patient preference, and feasibility of implementation. Adjunctive therapies to lifestyle interventions, including more effective pharmacotherapeutics for obesity, offer hope to patients and the potential for considerable improvements in health and quality of life.

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Section: Adjunctive Aomsmentioning

confidence: 99%

Approach to Obesity Treatment in Primary Care

Yanovski,

Yanovski

2024

JAMA Intern Med

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“…Adverse events from these medications such as gastroparesis, increased risk for ileus and perioperative aspiration have been reported. Other retrospective studies and meta‐analysis have documented other adverse events such as pancreatitis, and gallbladder/biliary disease, 127–130 however these have been controversial due to their retrospective nature and other limitations. Delayed GE from GLP‐1 RAs has been documented in multiple studies, 21,98,121,122,124–126,131 including a systematic review and meta‐analysis of almost 25,000 patients included in 60 trials of GLP‐1 RAs showed association of risk difference of nausea with absolute excess weight loss over placebo 93 .…”

Section: Glp‐1 Ra Risks and Implications In Clinical Practicementioning

confidence: 99%

“…A recent study was conducted in Canada with a large heath claims database that captured outpatient prescriptions of 16 million patients in the U.S.; 4757 using liraglutide or semaglutide were compared with 654 using bupropion/naltrexone, and it showed an increased risk of pancreatitis with hazard ratio (HR): 9.09 [95% CI: 1.25–66], bowel obstruction HR: 4.22 [95% CI: 1.02–17.40], and gastroparesis HR: 3.67 [95% CI: 1.15–11.90], but not biliary disease in the GLP‐1 agonists group compared to bupropion/naltrexone 130 …”

Section: Glp‐1 Ra Risks and Implications In Clinical Practicementioning

confidence: 99%

Review article: Pharmacologic management of obesity ‐ updates on approved medications, indications and risks

Lupianez‐Merly,

Dilmaghani,

Vosoughi

et al. 2024

Aliment Pharmacol Ther

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SummaryBackgroundObesity has reached epidemic proportions, with >40% of the US population affected. Although traditionally managed by lifestyle modification, and less frequently by bariatric therapies, there are significant pharmacological advancements.AimsTo conduct a narrative review of the neurohormonal and physiological understanding of weight gain and obesity, and the development, clinical testing, indications, expected clinical outcomes, and associated risks of current FDA‐approved and upcoming anti‐obesity medications (AOMs).MethodsWe conducted a comprehensive review in PubMed for articles on pathophysiology and complications of obesity, including terms ‘neurohormonal’, ‘obesity’, ‘incretin’, and ‘weight loss’. Next, we searched for clinical trial data of all FDA‐approved AOMs, including both the generic and trade names of orlistat, phentermine/topiramate, bupropion/naltrexone, liraglutide, and semaglutide. Additional searches were conducted for tirzepatide and retatrutide ‐ medications expecting regulatory approval. Searches included combinations of terms related to mechanism of action, indications, side effects, risks, and future directions.ResultsWe reviewed the pathophysiology of obesity, including specific role of incretins and glucagon. Clinical data supporting the use of various FDA‐approved medications for weight loss are presented, including placebo‐controlled or, when available, head‐to‐head trials. Beneficial metabolic effects, including impact on liver disease, adverse effects and risks of medications are discussed, including altered gastrointestinal motility and risk for periprocedural aspiration.ConclusionAOMs have established efficacy and effectiveness for weight loss even beyond 52 weeks. Further pharmacological options, such as dual and triple incretins, are probable forthcoming additions to clinical practice for combating obesity and its metabolic consequences such as metabolic dysfunction‐associated steatotic liver disease.

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“…JAMA publishes articles on research methods to advance the types of science that is important for clinical medicine, as well as commentaries and narrative essays to put the science in context. In the list of top-viewed and top-cited articles from 2023, all of these article types are represented: clinical trials and observational research studies in neurology, cardiology, infectious diseases, psychiatry, endocrinology, genetics, trial emulation methods, and more; editorials and commentaries, including a Viewpoint on the crisis of US child mortality rates; a narrative essay “Death by Patient Portal”; and clinical reviews on glioblastoma and other brain cancers, heart failure with preserved ejection fraction, autism spectrum disorder, and surgical site infections …”

Section: Top-viewed and Top-cited Articles From 2023mentioning

confidence: 99%

2023 Year in Review and What’s Ahead at JAMA

Bibbins-Domingo,

Flanagin,

Christiansen

et al. 2024

JAMA

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JAMA celebrated its 140-year anniversary in 2023. In reflecting on JAMA's origins and the descriptions of why JAMA was created, 1 one immediately recognizes the founding principles that still inform our priorities today. The earliest references to the creation of JAMA declare 1 : "But we shall spare neither time nor labor to complete such arrangements as will make the JOURNAL an efficient representative of the scientific, social, and ethical interests…," a sentiment that resonates with our current approach at JAMA.In this year-in-review editorial, we report on key metrics for JAMA. Based on the 2023 numbers (Table ), 2-6 JAMA continues to be a global leader in publishing quality clinical research, reviews, and opinion; having high impact, influence, and reach; and using multiple modes of publication. Here we focus on JAMA authors and readers whose work and interests are represented by these metrics, and the new initiatives launched at JAMA to serve authors, readers, and the broader medical and scientific communities.

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Risk of Gastrointestinal Adverse Events Associated With Glucagon-Like Peptide-1 Receptor Agonists for Weight Loss

Abstract: This database study examines the association between glucagon-like peptide 1 agonists (eg, semaglutide, liraglutide) used for weight loss and reports of gastrointestinal adverse events.

Cited by 96 publications

References 6 publications

Approach to Obesity Treatment in Primary Care

Approach to Obesity Treatment in Primary Care

Review article: Pharmacologic management of obesity ‐ updates on approved medications, indications and risks

2023 Year in Review and What’s Ahead at JAMA

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