Study, Year | Drug Dose (mg) | Co-Interventions | Sample Size (N), Race, Sex, Agea, Baseline BMIb | Length, Goal | Groups | Weight Change | Between-Group Differencesc | P Value | Patients Lost to Followup and Adverse Events | Trial Quality |
---|---|---|---|---|---|---|---|---|---|---|
Sibutramine | ||||||||||
Wirth and Krause, 200188 | 15 mg daily either continuous or intermitten | All participants: no formal diet, exercise,
or behavioral program
Written dietary information |
N: 1102 White: 99.8% Female: 77% Sibutramine: Cont: 43 yrs Int: 43 yrs Placebo: 44 yrs Sibutramine: Cont: 34.7 kg/m2 Int: 34.9 kg/m2 Placebo: 35.0 kg/m2 |
44 wks, L |
Sibutramine cont | -3.8 kg | -3.6 kg | < 0.001 | Sibutramine (continuous): Dropout: 79/405 Due to adverse event: 25/405 Adverse event rate: 303/405 Sibutramine (intermittent): Dropout: 80/395 Due to adverse event: 13/395 Adverse event rate: 283/395 Placebo: Dropout: 55/201 Due to adverse event: 9/201 Adverse event rate: 151/201 |
Good |
Sibutramine int | -3.3 kg | -3.1 kg | ||||||||
Placebo | -0.2 kg | |||||||||
5% loss: | ||||||||||
Sibutramine con | 65% | 30% | < 0.001 | |||||||
Sibutramine int | 63% | 28% | ||||||||
Placebo | 35% | |||||||||
10% loss: | ||||||||||
Sibutramine con | 32% | 19% | < 0.001 | |||||||
Sibutramine int | 33% | 20% | ||||||||
Placebo | 13% | |||||||||
Dujovne et al, 200185 | 20 mg daily | D All participants: Step I American Heart Association Diet (1500 kcal/d for females, 1800 kcal/day for males) |
N: 322 White: 82% Black: 12% Indian or Pakistani: 1% Mexican American: 2% Other: 3% Drug: 56% female Drug: 45 yrs Placebo: 35.5 kg/m2 |
24 wks, L |
Sibutramine | -4.9 kg | -4.3 kg | < 0.05 | Sibutramine: Dropout: 29.6% Due to adverse event: 9.9% Due to hypertension: 0.6% Placebo: Dropout: 33.8% Due to adverse event: 6.9% Due to hypertension: 1.9% |
Fair |
Placebo | -0.6 kg | |||||||||
5% loss: | ||||||||||
Sibutramine | 42% | 34% | < 0.05 | |||||||
Placebo | 8% | |||||||||
10% loss: | ||||||||||
Sibutramine | 12% | 9% | < 0.05 | |||||||
Placebo | 3% | |||||||||
Fujioka et al, 200086 | Titrated up to 20 mg daily | D All participants: 250-500 kcal/d caloric deficit diet with individual dietary counseling |
N: 175 White: 73% Black: 17% Other: 10% Female: 47% Sibutramine: 53.5 yrs Placebo: 55.0 yrs Sibutramine: 34.1 kg/m2 Placebo: 33.8 kg/m2 |
24 wks, L |
Sibutramine | -3.7 kg | -3.3 kg | < 0.5 | Sibutramine: Dropout: 29/89 Due to adverse event: 9/89 Placebo: Dropout: 25/86 Due to adverse event: 10/86 |
Fair |
Placebo | -0.4 kg | |||||||||
5% loss: | ||||||||||
Sibutramine | 27% | 26% | < 0.001 | |||||||
Placebo | 1% | |||||||||
10% loss: | ||||||||||
Sibutramine | 6% | 5% | 0.12 | |||||||
Placebo | 1% | |||||||||
Gokcel et al, 200132 | 10 mg bid | D All participants: 25 kcal/kg ideal body weight diet, with counseling at baseline |
N: 60 Race: NR Female: 100% Sibutramine: 47 yrs Placebo: 49 yrs Sibutramine: 39.3 kg/m2 Placebo: 37.4 kg/m2 |
24 wks, L |
Sibutramine | -3.9 kg | -4.3 kg | < 0.0001 | Sibutramine: Dropout: 1/30 Due to adverse event: 1/30 Placebo: Dropout: 5/30 Due to adverse event: NR |
Fair |
Placebo | 0.36 kg | |||||||||
Smith and Goulder, 200187 | 10 mg or 15 mg daily | D All participants: dietary advice |
N: 485 White: 99% Other: 1% Female: 80% Sibutramine: 10 mg: 41 yrs 15 mg: 43 yrs Placebo: 42 yrs Sibutramine: 10 mg group: 32.9 kg/m2 15 mg group: 32.7 kg/m2 Placebo: 32.4 kg/m2 |
52 wks, L |
Sibutramine: 10 mg |
-4.4 kg | -2.8 kg | < 0.01 | Sibutramine 10 mg: Dropout: 67/161 Due to adverse event: 2/161 Adverse event rate: 20/161 Sibutramine 15 mg: Dropout: 79/161 Due to adverse event: 2/161 Adverse event rate: 18/161 Placebo: Dropout: 83/163 Due to adverse event 4/163 Adverse event rate: 24/163 |
Fair |
Sibutramine: 15 mg |
-6.4 kg | -4.8 kg | ||||||||
Placebo | -1.6 kg | |||||||||
5% Loss: | ||||||||||
Sibutramine: 10 mg |
39% |
19% | < 0.01 | |||||||
Sibutramine: 15 mg |
57% | 37% | ||||||||
Placebo | 20% | |||||||||
10% Loss | ||||||||||
Sibutramine: 10 mg |
19% | 12% | < 0.01 | |||||||
Sibutramine: 15 mg |
34% | 27% | ||||||||
Placebo | 7% | |||||||||
McNulty et al, 200333 | 15-20 mg daily | D Standard dietary advice by a dietitian or nurse |
N: 195 Race: NR Female: 56% 15 mg group: 49 yrs 20 mg group: 48 yrs Placebo: 51 yrs Sibutramine: 15 mg group: 36.3 kg/m2 20 mg group: 37.5 kg/m2 Placebo: 36.2 kg/m2 |
12 mos, L |
Sibutramine: 15 mg |
-5.5 kg | -5.3 kg | < 0.001 | Sibutramine 15 mg: Dropout: 19/68 Due to adverse event: NR Sibutramine 20 mg: Dropout: 13/62 Due to adverse event: NR Placebo: Dropout: 18/64 Due to adverse event: NR |
Fair |
Sibutramine: 20 mg |
-8.0 kg | -7.8 kg | < 0.001 | |||||||
Placebo | -0.2 kg | |||||||||
5% Loss: | ||||||||||
Sibutramine: 15 mg |
46% | 34% | Sibutramine "significantly more" | |||||||
Sibutramine: 20 mg |
65% | 53% | ||||||||
Placebo | 12% | |||||||||
10% Loss: | ||||||||||
Sibutramine: 15 mg |
14% | 14% | NR | |||||||
Sibutramine: 20 mg |
27% | 27% | ||||||||
Placebo |
0% | |||||||||
James et al, 200084 | 10-20 daily | D,E,B All participants: high intensity individualized 600 kcal deficit diet |
N: 467 "Almost all" white Afro-Caribbean: 2% Asian: 1.5% Female: 84% Sibutramine: 41 yrs Placebo: 40 yrs Sibutramine: 36.5 kg/m2 Placebo: 36.6 kg/m2 |
80 wks, M (following 6 mos L phase) |
Sibutramine |
-8.9 kg | -4 kg | < 0.001 | Sibutramine: Dropout: 148/352 Due to adverse event: 48/352 Placebo: Dropout: 58/115 Due to adverse event: 6/115 |
Fair |
Placebo | -4.9 kg | |||||||||
Maintaining >80% of original loss: | ||||||||||
Sibutramine | 41% | |||||||||
Placebo | 14% | 27% | < 0.001 | |||||||
Orlistat | ||||||||||
Muls et al, 200191 | 120 mg | D All participants: moderate-intensity dietary advice from a dietitian (-600 kcal/day) |
N: 294 Race: NR Orlistat: 82% Female Placebo: 78% Female Orlistat: 50 yrs Placebo: 48 yrs 33 kg/m2s |
24 wks, L | Orlistat | -4.66 kg | -2.78 kg | < 0.001 | Orlistat Dropout: 19/147 (13%) Adverse event rate: 80%d GI Adverse event: 64% Placebo: Dropout: 16/147 (11%) Adverse event rate: 67% GI adverse event rate: 38% |
Good |
Placebo | -1.88 kg | |||||||||
Mean Change: | ||||||||||
Orlistat | -5.3% | -3% | < 0.001 | |||||||
Placebo | -2.3% | |||||||||
5% loss: | ||||||||||
Orlistat | 64% | 25% | NR | |||||||
Placebo | 39% | |||||||||
10% loss: | ||||||||||
Orlistat | 23% | 10% | NR | |||||||
Placebo | 13% | |||||||||
Van Gaal et al, 199889 | 30, 60, 120, or 240 mg tid | D All participants: high-intensity dietary advice from a dietitian |
N: 613 Race: NR Female: 77% Range: 40-44 yrs (varied by group) 34-35 kg/m2 (varied by group) |
52 wks, L |
Orlistat: 30 mg | -8.5% | -2% | < 0.001 | Orlistat 30 mg: Dropout: 29/122 Due to adverse event: 7/122 Adverse event rate: 79% Orlistat 60 mg: Dropout: 29/124 Due to adverse event: 6/124 Adverse event rate: 83% Orlistat 120 mg: Dropout: 23/122 Due to adverse event: 2/122 Adverse event rate: 84% Orlistat 240 mg: Dropout: 20/120 Due to adverse event: 3/120 Adverse event rate: 87% Placebo: Dropout: 27/125 Due to adverse event 3/125 Adverse event rate: 69% |
Fair |
Orlistat: 60 mg | -8.8% | -2.3% | ||||||||
Orlistat: 120 mg | -9.8% | -3.3% | ||||||||
Orlistat: 240 mg | -9.3% | -2.8% | ||||||||
Placebo | -6.5% | |||||||||
10% Loss: | ||||||||||
Orlistat: 30 mg | 28% | 9% | NR | |||||||
Orlistat: 60 mg | 28% | 9% | ||||||||
Orlistat: 120 mg | 37% | 18% | ||||||||
Orlistat: 240 mg | 38% | 19% | ||||||||
Placebo | 19% | |||||||||
Micic et al, 199994 | 120 mg tid | D All participants: mildly hypocaloric diet with dietary advice |
N: 119 Race: NR Orlistat: 70% female Placebo: 78% female Orlistat: 46 yrs Placebo: 45 yrs (median ages) Orlistat: 34.8 kg/m2 Placebo: 35.2 kg/m2 |
24 wks, L |
Orlistat | -10.8 kg | -3.5 kg | 0.001 | Orlistat: Dropout: 10/60 Due to adverse event: 1/60 Adverse event rate: 18/60 Placebo: Dropout: 10/59 Due to adverse event: NR Adverse event rate: 7/59 |
Fair |
Placebo | -7.3 kg | |||||||||
Rissanen et al, 200195 | 120 mg tid | D All participants: 600 kcal deficit diet |
N: 51 Race: NR Female: 100% Age: 44 yrs 36.2 kg/m2 |
12 mos, L |
Orlistat |
-13 kg | -5.8 kg | NS | Dropout: 4/55 | Fair |
Placebo | -7.2 kg | |||||||||
Broom et al, 200296 | 120 mg tid | D All participants: mildly hypocaloric diet (minimum of 1200 kcal/day), with food and beverage diaries |
N: 531 Race: NR Female: 78% Orlistat: 46.7 yrs Placebo: 45.3 yrs Orlistat: 37.1 kg/m2 Placebo: 37.0 kg/m2 |
54 wks, L |
Orlistat | -5.8 kg | -3.5 kg | < 0.001 | Orlistat: Dropout: 79/265 Due to adverse event: 20/265 Due to GI symptoms: 13/265 Serious adverse events: 13/265 Placebo: Dropout: 105/266 Due to adverse event: 11/266 Due to GI symptoms: 6/266 Serious adverse events: 17/266 |
Fair |
Placebo | -2.3 kg | |||||||||
>5% Loss: | ||||||||||
Orlistat | 55.6% | 31.3% | < 0.001 | |||||||
Placebo | 24.3% | |||||||||
>10% Loss: | ||||||||||
Orlistat | 19.7% | 8.7% | NS | |||||||
Placebo | 11.0% | |||||||||
Miles et al, 200290 | 120 mg tid | D, E All participants: recommended to increase physical activity and diet (-600 kcal/day) with dietary counseling throughout the study |
N: 516 Orlistat: White: 84% Black: 10% Other: 6% Placebo: White: 79% Black: 14% Other: 7% Female: 48% Orlistat: 52.5 yrs Placebo: 53.7 yrs Orlistat: 35.2 kg/m2 Placebo: 35.6 kg/m2 |
52 wks, L |
Orlistat | -4.7 kg | -2.9 kg | < 0.001 | Orlistat: Dropout: 35% Due to adverse event: 10% Due to GI symptoms: NR GI event frequency: 83% Placebo: Dropout: 44% Due to adverse event: 5% Due to GI symptoms: NR GI event frequency: 62% |
Fair |
Placebo | -1.8 kg | |||||||||
> 5% Loss: | ||||||||||
Orlistat | 39.0% | 23.3% | 0.008 | |||||||
Placebo | 15.7% | |||||||||
> 10% Loss: | ||||||||||
Orlistat | 14.1% | 10.2% | 0.003 | |||||||
Placebo | 3.9% | |||||||||
Karhunen et al, 200093 | 120 mg tid | D All participants: dietary advice (-600 kcal/day) individualized advice throughout the 1 yr loss phase |
N: 96 Race: NR Female: 82% Age: 43 yrs 35.9 kg/m2 |
2 yrs: 1 yr of L 1 yr of M |
Loss phase | Yr 1 | No data on adverse effects Dropout: 24/96 (25%) Due to adverse event: NR |
Fair | ||
Orlistat | -13.1 kg | -4.5 kg | 0.007 | |||||||
Placebo | -8.6 kg | |||||||||
Maintenance phase | ||||||||||
(Tx Yr 1/Tx Yr 2) | Yr 2 only | |||||||||
Orlistat/Orlistat | 3.1 kg | |||||||||
Orlistat/Placebo | 6.3 kg | |||||||||
Placebo/Orlistat | 0.5 kg | |||||||||
Placebo/Placebo | 3.5 kg | |||||||||
Hill et al, 199992 | 30, 60, or 120 mg 3 times daily | D, E, B All participants: 4180 kJ/day deficit diet Multi-vitamin |
N: 729 White: 88 Black: 6% Hispanic: 5% Other: 1% Female: 84% Orlistat: 30 mg: 47 yrs 60 mg: 46 yrs 120 mg: 46 yrs Placebo: 46 yrs Orlistat: 30 mg: 32.6 kg/m2 60 mg: 32.9 kg/m2 120 mg: 32.8 kg/m2 Placebo: 32.8 kg/m2 |
52 wks M (following 6 mos of L) |
Orlistat 30 mg | 4.9 kg | 0.5 kg | < 0.001 | Orlistat 30 mg: Dropout: 47/187 Due to adverse event: 17/187 Orlistat 60 mg: Dropout: 40/173 Due to adverse event: 17/173 Orlistat 120 mg: Dropout: 55/181 Due to adverse event: 27/181 Placebo: Dropout: 50/188 Due to adverse event: 5/188 |
Fair |
Orlistat 60 mg | 3.8 kg | -0.6 kg | ||||||||
Orlistat 120 mg | 2.6 kg | -1.8 kg | ||||||||
Placebo | 4.4 kg | |||||||||
Giugliano et al, 199397 | 850 mg bid | Counseled to maintain baseline diet and exercise patterns | N: 50 Race: NR Female: 62% Metformin: 60 yrs Placebo: 60.8 yrs Metformin: 33 kg/m2 Placebo: 32.7 kg/m2 |
6 mos, L |
Metformin Placebo |
Data in graph form | Data in graph form | NS | NR | Fair |
Knowler et al.81 | 850 mg bid (titrated up) | D,E Metformin and placebo participants: written information plus annual 20-30 minute individual session emphasizing low-fat diet and physical activity |
N: 3234 White: 55% Black: 20% Hispanic: 16% Native American: 5% Asian: 4% Female: 68% Mean: 51 yrs 34 kg/m2 |
2.8 yrs, L & M |
Metformin | -2.1 kg | -2.0 kg | < 0.001 | 7.5% | Good |
Lifestyle | -5.6 kg | -5.5 kg | ||||||||
Placebo | -0.1 kg | |||||||||
Mulitple Drugs | ||||||||||
Gokcel et al, 200298 | Sibutramine: 10 mg bid Orlistat: 120 mg tid Metformin: 850 mg bid |
D 25 kcal per kg of ideal body weight with caloric distribution: 50% carbohydrates 30% lipids 20% protein |
N: 150 Race: NR Female: 100% Sibutramine: 42.3 yrs Orlistat: 42.1 yrs Metformin: 43.6 yrs Sibutramine: 38.5 kg/m2 Orlistat: 35.3 kg/m2 Metformin: 37.9 kg/m2 |
6 mos, L |
Sibutramine | -13.4 kg | -4.0 kg 1.0 kg (vs metformin) |
BMI loss significantly greater with sibutramine than either other group | Sibutramine: Dropout: NR Due to adverse event: 2/50 Orlistat: Dropout: NR Due to adverse event: 2/50 Metformin: Dropout: NR Due to adverse event: NR |
Fair |
Orlistat | -8.0 kg | |||||||||
Metformin | -9.0 kg | |||||||||
Notes: B = behavioral therapy; bid = twice daily; BMI = body mass index; cont = continuous; D = diet; E = exercise; GI = gastrointestinal; int = intermittent; L = weight loss; M = maintenance of weight loss; NR = not reported; tid = three times daily. a Values are means unless otherwise indicated. |