Hormonal
Long-term use of FDA-approved GLP-1/GIP agonists (tirzepatide and semaglutide) produces significant weight loss and metabolic improvements in real-world populations, though efficacy is lower than in randomized clinical trials due to conservative dosing and adherence issues.
Tirzepatide and semaglutide are highly effective for weight loss in real-world settings, but results vary. Expect that only about 1/3 to 2/5 of users will lose 10% of their body weight, even with long-term use. This is lower than clinical trial promises due to lower real-world doses and adherence. Consistency and appropriate dosing are key.
For both cohorts, F-AOMs generally showed superior weight loss effects than O-AOMs. Tirzepatide and semaglutide were the most effective F-AOMs... Both medications also benefited HDL, LDL, triglyceride, and HbA1c levels... The disparity can be explained as follows. Firstly, the dosages used in real-world clinical settings tend to be more conservative... Thirdly, medication adherence in real-world practice is generally less strict than in RCTs.
Why this rating
Large-scale EHR data (up to 30M patients) provides high statistical power, though it is observational.
Source
Current status of anti-obesity medications and performance, an EHR based survey
Xiaoyang Ruan et al. · medRxiv · 2024
DOI 10.1101/2024.12.02.24318314
More from this paper
- Discontinuation of FDA-approved GLP-1/GIP agonists (tirzepatide, semaglutide) does not lead to significant weight regain at the population level, contrasting with off-label drugs like phentermine and zonisamide which cause substantial regain.Good
- There is significant individual variability in response to all anti-obesity medications, with a substantial subset of patients experiencing weight gain or failing to achieve target weight loss, regardless of the drug class.Good
Related findings · Hormonal
- Initial treatment for type 2 diabetes should be a combination of metformin and either an SGLT-2 inhibitor or a GLP-1 receptor agonist to achieve cardiorenal protection, rather than monotherapy or older agents like sulfonylureas.Strong
- For patients with specific monogenic obesity syndromes (leptin deficiency, POMC/PCSK1/LEPR mutations), targeted pharmacotherapy (recombinant leptin or setmelanotide) is highly effective and should be prioritized, unlike in polygenic obesity.Strong
- Continued weekly administration of 2.4 mg subcutaneous semaglutide prevents weight regain and promotes further weight loss in adults with overweight or obesity, whereas switching to placebo results in significant weight regain.Strong
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