Obesity Drug Comparison Ranks Semaglutide Tops for Weight Loss, Waist Reduction

Semaglutide and phentermine/topiramate were associated with more weight loss and waist circumference reduction at 12 months compared with other obesity drugs, according to results from a systematic review and network meta-analysis published in Diabetes, Obesity and Metabolism.

“Semaglutide and phentermine/topiramate were associated with 8-9 kg of body weight loss and 6-7 cm of waist circumference reduction at 12 months compared with placebo and were more effective than all other drugs, with similar or lower risks of withdrawal from treatment because of adverse events,” wrote corresponding author Andrea Iannone, PhD, of the University of Bari in Italy, and coauthors.

The systematic review with network meta-analysis included 168 randomized controlled trials involving 97,938 participants. Researchers were interested in identifying the most effective and safe weight-loss drugs in adults with obesity or overweight.

The investigation found no significant difference in association between any drug with odds of cardiovascular death. However, combined treatment with naltrexone and bupropion was associated with lower risk of cardiovascular death compared with placebo.

At 12 months, all drugs were associated with more weight loss than placebo. At 9.02 kg of weight loss compared with placebo, semaglutide ranked highest. Next highest was phentermine/topiramate, with 8.10 kg of weight loss compared with placebo, according to the study.

Additionally, all drugs were associated with greater waist circumference reduction than placebo. Waist circumference reduction at 12 months was 7.84 cm more with semaglutide and 6.20 cm more with phentermine/topiramate compared with placebo.

The odds of treatment withdrawal were lower or no different with semaglutide and phentermine/topiramate compared with other drugs.

“Taken together...semaglutide appears to show favorable associations with lowering body weight, as well as reducing waist circumference and blood pressure, without excess withdrawal from adverse events,” researchers wrote. “Based on current trials, there is no evidence that semaglutide or other weight-lowering drugs have different associations with cardiovascular complications or death, and suggest that clinicians and patients may select drug management based on their efficacy related to body weight loss and waist circumference reductions.”

Reference:
Iannone A, Natale P, Palmer SC, et al. Clinical outcomes associated with drugs for obesity and overweight: a systematic review and network meta-analysis of randomized controlled trials. Diabetes Obes Metab. Published online May 31, 2023. doi:10.1111/dom.15138