Tools for Practice Outils pour la pratique


#314 Weight to Go: Naltrexone/bupropion for weight loss


CLINICAL QUESTION
QUESTION CLINIQUE
 Is naltrexone/bupropion (Contrave®) effective for weight loss?

BOTTOM LINE
RÉSULTAT FINAL
 Over 28-56 weeks, at best, ~50% of patients taking naltrexone/bupropion achieved a >5% loss in body weight, compared to ~20% in control. Naltrexone/bupropion adverse events (examples nausea, constipation) lead to withdrawal in 23% of patients versus 12% on placebo.


CFPCLearn Logo

Reading Tools for Practice Article can earn you MainPro+ Credits

La lecture d'articles d'outils de pratique peut vous permettre de gagner des crédits MainPro+

 Join Now S’inscrire maintenant

Already a CFPCLearn Member? Log in

Déjà abonné à CMFCApprendre? Ouvrir une session


EVIDENCE
DONNÉES PROBANTES
  • Focused on systematic reviews with meta-analysis of randomized, placebo-controlled trials (RCTs). Results statistically significant unless noted.
  • Systematic review, 4 RCTs, 3955 patients who received at least one dose, baseline weight 100kg.1 Both arms included lifestyle changes (e.g., 500kcal/day deficit, increase activity). Naltrexone-bupropion (titrated to 16/180mg BID) versus placebo. At 56 weeks:
    • Participants with ≥5% weight loss: Naltrexone/bupropion 53% versus placebo 21%, number needed to treat (NNT)=4.
    • ≥10% weight loss: Naltrexone/bupropion 29% versus placebo 9%, NNT=5.
    • Mean weight loss (2 RCTs reporting): ~ 6 kg versus ~1 kg control.
    • Withdrawals due to adverse effects: 25% versus 13% placebo, number needed to harm (NNH)=8.
    • Other systematic reviews found similar.2-4
  • Systematic review, same 4 RCTs as above except included lower dosage arm (8/180mg BID) and used all randomized participants, 4536 patients.5
    • Outcomes at 28-56 weeks:
      • ≥5% weight loss: Naltrexone/bupropion 38% versus placebo 17%, NNT=5.
      • ≥10% weight loss: Naltrexone/bupropion 22% versus placebo 8%, NNT=8.
      • Mean weight loss: ~4.5kg versus 2kg (placebo).
      • Withdrawals due to adverse events: 23% versus 12% (placebo), NNH=10.
      • Most common adverse events include nausea (31% versus 7% placebo) and constipation (18% versus 7% placebo).
  • Limitations: All RCTs were industry funded, high dropout rates (~45%), inconsistent magnitude of effects across RCTs but all showed benefit.
Context
  • Trial looking at cardiovascular safety stopped early due to data breach, however, systematic review of 5 RCTs found no association with cardiovascular events.6-7
  • Weight regain after stopping medication unknown.
  • Cost (1 month)8: ~$350 (generally not covered). Off-label prescribing of individual components at lower doses ~$80.9 
  • Other medications for weight loss include (with mean weight loss in RCTs): Orlistat (~2.6kg)1 or GLP-1 agonists such as semaglutide (~10-15kg)10 or liraglutide (~5kg)11. Baseline weight in studies ~101-106kg.

Richard Poole May 10, 2022

Valuable info for my patients

Sophie-Anne Bouchard-Cyr May 16, 2022

More effective than victoza?

Maureen Kennedy June 5, 2022

more studies needed

Latest Tools for Practice
Derniers outils pour la pratique
program image
Adrienne J Lindblad BSP ACPR PharmD

#377 How to slow the flow IV: Combined oral contraceptives

In premenopausal heavy menstrual bleeding due to benign etiology, do combined oral contraceptives (COC) improve patient outcomes?
Read Lire 0.25 credits available Crédits disponibles
program image
Jennifer Potter MD CCFP

#376 Testosterone supplementation for cis-gender men: Let’s (andro-)pause for a moment (Update)

What are the benefits and harms of testosterone supplementation in healthy cis-gender men or those with age-related low testosterone?
Read Lire 0.25 credits available Crédits disponibles
program image
Betsy Thomas BScPharm

#375 Pharm for Fibro: Can antidepressants ease the pain?

Do antidepressants reduce pain in patients with fibromyalgia?
Read Lire 0.25 credits available Crédits disponibles
May 2, 2022

This content is certified for MainPro+ Credits, log in to access

Ce contenu est certifié pour les crédits MainPro+, Ouvrir une session
Author(s)
Auteur(s)
  • Betsy Thomas BSc. Pharm
  • Adrienne J Lindblad BSP ACPR PharmD
  • Thao Luu BScPharm PharmD candidate
  • Allison Paige MD CCFP

1. Khera R, Murad MH, Chandar AK, et al. JAMA. 2016 Jun 14; 315(22):2424-34.

2. Singh A, Singh R. Expert Rev Clin Pharmacol. 2020 Jan; 13(1):53-64.

3. Khalil H, Ellwood L, Lord H, et al. Ann Pharmacother. 2020 Jul; 54(7):691-705.

4. LeBlanc EL, Patnode CD, Webber EM, et al. Rockville (MD): Agency for Healthcare Research and Quality (US); 2018 Sep. Report No.: 18-05239-EF-1.

5. Onakpoya IJ, Lee JJ, Mahtani KR, et al. Br J Clin Pharmacol. 2020 Apr; 86(4):646-667.

6. Nissen SE, Wolski KE, Prcela L, et al. JAMA. 2016 Mar 8; 315(10):990-1004.

7. Sposito AC, Bonilha I, Luchiari B, et al. Cardiovascular safety of naltrexone and bupropion therapy: Systematic review and meta-analyses. Obes Rev. 2021 Jun; 22(6):e13224.

8. Alberta Blue Cross Drug Price List effective April 14, 2022. Available at: https://www.ab.bluecross.ca/dbl/pdfs/ABCDPL_2022_04_07.pdf. Accessed on April 14, 2022.

9. Alberta Blue Cross Interactive Drug Benefit List. Available at: https://idbl.ab.bluecross.ca/idbl/load.do. Accessed on April 14, 2022.

10. Ojeniran M, Dube B, Paige A, et al. Tools for Practice #295. Available at: https://gomainpro.ca/wp-content/uploads/tools-for-practice/1627498844_tfp295_semaglutidealupdated.pdf. Accessed on February 1, 2022.

11. Antony N, Korownyk C. Tools for Practice #168. Available at: https://gomainpro.ca/wp-content/uploads/tools-for-practice/1471016146_tfp168liraglutidefv2.pdf. Accessed on February 1, 2022.

Authors do not have any conflicts of interest to declare.

Les auteurs n’ont aucun conflit d’intérêts à déclarer.