#168 Liraglutide: Weighing the evidence for weight loss?
CLINICAL QUESTION
Does liraglutide reduce weight and improve health in obese patients?
BOTTOM LINE
Once daily Liraglutide 3.0 mg injections reduce weight 3.4%-4.6 % over one year and one in 3-4 patients treated will get a 5% weight loss over placebo. Adverse events (like nausea and vomiting) will cause one in 17 to stop liraglutide. The effect was not sustained beyond drug cessation and long-term health effects in obese non-diabetics are unknown.
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EVIDENCE
- Primarily two large industry-funded randomized controlled trials (RCTs) assessing liraglutide injection for weight loss:
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- 3,731 non-diabetic obese (mean 106 kg) patients.1 Over 56 weeks, daily 3.0 mg liraglutide versus placebo resulted in:
- Intention to treat analysis:2 4.6% (5 kg) reduction in total body weight.
- 63% versus 27% lost ≥5% body weight, Number Needed to Treat (NNT)=3.
- 33% versus 11% lost >10% body weight, NNT=5.
- 12 weeks after stopping, subjects regained ~2.9% initial body weight.
- 846 diabetic obese (mean 106 kg) patients, 3.0 mg, 1.8 mg liraglutide, or placebo for 56 weeks.3
- Weight loss compared to placebo for 3.0 mg and 1.8 mg liraglutide was:
- Intention to treat analysis:2 3.4% and 2.5% respectively.
- Weight loss compared to placebo for 3.0 mg and 1.8 mg liraglutide was:
- 3,731 non-diabetic obese (mean 106 kg) patients.1 Over 56 weeks, daily 3.0 mg liraglutide versus placebo resulted in:
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- 3.0 mg liraglutide versus placebo:
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- 54% versus 21% lost ≥5% body weight, NNT=4.
- 25% versus 7% lost ≥10% body weight, NNT=6.
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- Adverse Events: Nausea [Number Needed to Harm (NNH)~4] and vomiting (NNH ~9).2
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- Withdrawal due to adverse events:4 10% Liraglutide versus 4% placebo, NNH=17.
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- Smaller RCTs support these findings.5,6
- 5% weight loss is suggested as potentially meaningful.7 However, 17% weight loss was needed for the severely obese (BMI 46-49) to attain a minimally clinically significant improvement in quality of life.8
- Liraglutide 1.8 mg is indicated for Type 2 Diabetes9 and 3.0 mg dose for weight loss.10
- Canadian cost for 3.0 mg liraglutide is ~$400/month.
- Fit-obese individuals have similar mortality to fit-normal weight individuals.11
- In diabetic patients (mean BMI 32 and weight 92 kg), liraglutide led to a 13% relative reduction in cardiovascular events (NNT=53) over ~4 years.12
- Long-term outcomes in obese non-diabetics are unknown.
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