Background

Previously conducted clinical trials suggested that Qsymia (phentermine-topiramate) induces the greatest amount of weight loss, with Saxenda (liraglutide) and Contrave (bupropion-naltrexone) following closely behind in efficacy, however, data on efficacy the these medications in clinical practice is limited. Objective was to examine the efficacy of medication in outpatient surgical clinic.

Methods

We examined EMR of 503 patients prescribed one of the aforementioned medications on outpatient bariatric clinic in 2014 -2019. We applied generalized linear modeling to examine association of change in BMI with specific pharmacologic treatments adjusted for age, sex, and race.

Results

While 16.3% of patients who received pharmacologic intervention experienced a reduction of BMI, 21.8% saw no change in BMI. Of patients who saw reduction in BMI, 12% had previously underwent a bariatric procedure. In patients prescribed Contrave, there was a statistically significant difference (p=.04) in BMI change based on race; this finding was present in patients taking Qsymia, Phentermine, and Saxenda as well, albeit at a 92% confidence interval (p value=0.067, 0.059, and 0.068 respectively). Of note, the average change in BMI was significantly different between patients taking Saxenda and those who did not (92% confidence, p=0.053).

Conclusions

These findings suggest that medical management of obesity is a valid treatment option. The effect of Saxenda as an adjunct treatment in patients taking anti-obesity medications should be explored in a larger sample size. Further investigation into how weight loss medications may work synergistically and the impact of other environmental/cultural factors influencing weight loss is warranted.