Bariatric treatments for adult obesity - Institute of Health Economics

Table T.F.3-3: Risk factors/comorbidities Pharmacotherapy 20Risk factors Orlistat Sibutramine RimonabantBloodpressureGlycemicparametersLipidparametersFraminghamrisk scoreCardiovascularmorbidityOrlistat resulted in placebo-subtracted SBP reductions of1.5 mmHg (95% CI: 0.9 to 2.2; 13 trials) and DBPreduction of 1.4 mmHg (95% CI: 0.7 to 2.0; 12 trials).Orlistat reduced the incidence of T2DM from 9.0% to6.2% (HR 0.63, 95% CI: 0.46 to 0.86) in the XENDOStrial; this benefit was primarily observed in patients withimpaired glucose tolerance at baseline.Compared to placebo, orlistat reduced total cholesterollevels by 0.32 mmol/L (95% CI: 0.28 to 0.37; 13 trials),LDL cholesterol levels by 0.26 mmol/L (95% CI: 0.22 to0.30; 13 trials) and HDL cholesterol by 0.03 mmol/L(95% CI: 0.02 to 0.04; 11 trials); the change in TG wasnot significantly different.See adverse events Rimonabant reduced placebo-subtracted SBP by 1.8mmHg (95% CI: 0.8 to 2.8; three trials) and DBP by1.2 mmHg (95% CI: 0.5 to 1.9; three trials).Inconsistently reported; when reported, nodifference from placebo in any study, even inpatients with diabetesCompared to placebo, sibutramine increasedHDL cholesterol levels 0.04 mmol/L (95% CI:0.01 to 0.08 mmol/L; five trials) and reducedTG levels by 0.18 mmol/L (95% CI: 0.07 to0.30 mmol/L; four trials)No significant difference (one trial) N/A N/AN/A N/A N/AMortality N/A N/A N/AWeightmaintenanceWeight regain: comparable between the two groups.Weight differential between the two groups after weightloss phase preserved.Changes in serum lipid and glucose values duringmaintenance phase were similar to weight loss phase ineach trial.N/AFasting glucose levels were reduced in one trial by 1mmol/L (95% CI: 0.6 to 1.3) and HbA1c reduced by0.7% (95% CI: 0.6 to 0.8). No clinically or statisticallysignificant reductions were demonstrated in otherstudies.Compared to placebo, rimonabant increased HDLcholesterol levels by 0.1 mmol/L (95% CI: 0.08 to0.11; four trials) and reduced TG levels by 0.24mmol/L (95% CI: 0.17 to 0.30; four trials). Changes intotal cholesterol and LDL cholesterol were notsignificant.N/ABariatric treatments for adult obesity 146