Bariatric treatments for adult obesity - Institute of Health Economics

Because extreme obesity can potentially affect all organ systems and psychological health, optimalsurgical treatment of weight loss requires communication and collaboration among amultidisciplinary team of caregivers. 47Regulatory statusMedicationsHealth CanadaOrlistat (Xenical ® , manufactured by Hoffmann-La Roche Ltd, Ontario, Canada) and sibutramine(manufactured as Apo-Sibutramine ® by Apotex Incorporated, Ontario, Canada, and as Meridia ® byAbbott Laboratories, Ltd, Québec, Canada) are two drugs currently approved by Health Canada forthe treatment of obesity. 48-50In October 2010 Health Canada announced that Abbott Laboratories had voluntarily withdrawn theprescription weight loss drug sibutramine (Meridia ® ) from the Canadian market. The decision wasmade based on the data from the Sibutramine Cardiovascular OUTcomes (SCORT) trial, a large trialthat suggested an increased risk of serious cardiovascular events associated with sibutramine use inpatients with heart problems. 51OtherIn January 2010 the European Medicines Agency recommended suspension across the EuropeanUnion of marketing authorizations for sibutramine-containing medicines, including Reductil,Reduxade, Zelium, and other trade names. 22 The decision was made based on the EuropeanMedicines Agency’s most recent safety review, which had found an increased risk of cardiovascularevents associated with the use of sibutramine-containing medicines.At the same time, at the request of the US FDA, the manufacturer of sibutramine agreed to add anew contraindication to the sibutramine drug label. 23 The contraindication will state that sibutramineis not to be used in patients with a history of cardiovascular disease, including a history of:coronary artery disease (for example: heart attack, angina)stroke or transient ischemic attackheart arrhythmiascongestive heart failureperipheral arterial disease uncontrolled hypertension (that is, > 145/90 mmHg)Rimonabant (Acomplia ® and Zimulti ® ) was granted a community marketing authorization by theEuropean Commission on 19 June 2006. 52 The European Medicines Agency has recommended thesuspension of marketing authorization for this drug as of 23 October 2008 because of the risk ofpsychiatric side-effects. 53Bariatric treatments for adult obesity 73