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Sibutramine beats orlistat for weight loss

By Nigel Praities

Patients lose more weight with sibutramine than orlistat, say the authors of the first meta-analysis of data from head-to-head trials of obesity medication.

Researchers found sibutramine was significantly more efficacious, with a median weight loss of 11.7 kg, compared with 8.0 kg for orlistat.

Sibutramine also had lower drop-out rates compared with orlistat, although this difference was not significant. Rimonabant was not included in the analysis as no comparative trials were found.

Study leader Dr Martin Neovius, a researcher at the Karolinska Institute's obesity unit in Stockholm, said: ‘Together with careful consideration of side-effects and contraindications, this find could be incorporated into the decision-making of the clinician in the process of selecting appropriate pharmacotherapy for obese patients.'

A meta-analysis of treatments released last year in the BMJ sparked a row, after it claimed obesity drugs were only of ‘modest' help in helping people lose weight. In this analysis, patients on sibutramine lost an average of 1.3kg more than those on orlistat, but 0.5 kg less than those on rimonabant.

Dr David Haslam, clinical director of the National Obesity Forum, said these findings were ‘generally accepted' but GPs should still tailor treatments to needs of the individual patient.

‘You have got to look at all the other risk parameters as well, orlistat has shown a reduction in a diagnosis of diabetes by 15%. So although the weight loss induced is less the evidence of benefit is more,' he said.

The meta-analysis was published early online in Obesity Reviews.


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