Journal Article

A comparative study of five centrally acting drugs on the pharmacological treatment of obesity

Suplicy, H, Boguszewski, C L, dos Santos, C M C, Radominski, R, Cunha, D R, do Desterro de Figueiredo, M

2014

Overview

Context: No long-term studies have compared centrally acting drugs for treating obesity. Objective: To compare the efficacy and safety of diethylpropion (DEP), fenproporex (FEN), mazindol (MZD), fluoxetine (FXT) and sibutramine (SIB) in promoting weight loss. Design and Setting: A prospective, randomized, placebo (PCB)-controlled study conducted at a single academic institution. Patients: A total of 174 obese premenopausal women. Intervention: Participants randomly received DEP 75 mg ( n =28), FEN 25 mg ( n =29), MZD 2 mg ( n =29), SIB 15 mg ( n =30), FXT 20 mg ( n =29) or PCB ( n =29) daily over 52 weeks. Diet and physical activity were encouraged. Main Outcome Measures: The primary endpoints were changes in body weight and the proportion of women who achieved at least 5% weight loss by week 52 in the intent-to-treat population. Other measurements included anthropometry, safety, metabolic and cardiovascular parameters. Results: Weight loss was greater than PCB (−3.1±4.3 kg) with DEP (−10.0±6.4 kg; P< 0.001), SIB (−9.5±5.9 kg; P< 0.001), FEN (−7.8±6.9 kg; P< 0.01) and MZD (−7.4±4.9 kg; P< 0.01) but not with FXT (−2.5±4.1 kg). Ten (33.3%) women lost⩾5% of their initial weight with PCB, compared with 20 (71.4%; P< 0.001) with DEP, 20 (69%; P< 0.02) with FEN, 21 (72.4%; P< 0.01) with MZD, 22 (73.3%; P< 0.001) with SIB and 10 (35.5%) with FXT. Each medically treated group experienced more adverse events compared with PCB ( P< 0.001). Compared with PCB, constipation was more prevalent with DEP, SIB and MZD ( P< 0.01); anxiety was more prevalent with DEP ( P= 0.01); and irritability occurred more frequently with DEP and FEN ( P= 0.02). Significant improvements in the depression and anxiety scores, binge-eating episodes and quality of life correlated with weight loss. CONCLUSION: The centrally acting drugs DEP, FEN, MZD and SIB were more effective than PCB in promoting weight loss in obese premenopausal women, with a satisfactory benefit–risk profile.

• Publisher: Nature Publishing Group UK,Nature Publishing Group
• Subject: 692/699/2743/393 / 692/700/565/1436 / Adult / Amphetamines - therapeutic use / Anthropometry / Anti-Obesity Agents - therapeutic use / Anxiety / Biological and medical sciences / Body Mass Index / Body weight / Body weight loss / Brazil / Cholesterol / Comparative studies / Complications and side effects / Constipation / Cyclobutanes - therapeutic use / Diet, Reducing / Diethylpropion - therapeutic use / Drug therapy / Drugs / Eating behavior / Epidemiology / Female / Fluoxetine / Fluoxetine - therapeutic use / Follow-Up Studies / Gastrointestinal surgery / Health aspects / Health Promotion and Disease Prevention / Humans / Internal Medicine / Mazindol - therapeutic use / Medical sciences / Medicine / Medicine & Public Health / Mental depression / Metabolic Diseases / Metabolism / Obesity / Obesity - drug therapy / Obesity - prevention & control / original-article / Patient outcomes / PCB / Pharmaceuticals / Physical activity / Polychlorinated biphenyls / Prospective Studies / Public Health / Quality of life / Risk assessment / Safety / Sibutramine / Substance abuse treatment / Surveys and Questionnaires / Treatment Outcome / Weight control / Weight loss / Weight Loss - drug effects / Weight loss measurement / Womens health