BACKGROUND: This study fills a gap in the current guidelines for paediatric obesity treatment by providing quantitative data and comparing the effectiveness of weight loss drugs in children and adolescents with that in adults. Researchers developed a pharmacodynamic model to evaluate the efficacy and influential factors of various weight loss drugs.
METHOD: A systematic search of public databases was performed to include randomized placebo-controlled clinical studies on pharmacological treatment of obesity in children and adolescents. Efficacy characteristics of different weight-loss medications and their influencing factors were characterized by constructing time-course and covariate models, and performing subgroup analyses. These were then compared with efficacy models for adult patients to investigate differences in drug effectiveness between the two age groups.
RESULTS: A comprehensive review of 31 articles involving 1723 participants from public databases was conducted. The analysis demonstrated that baseline Body Mass Index (BMI) significantly affected weight loss outcomes. To control for study variations, baseline BMI values were standardised to a median of 35.3 kg/m, and placebo effects were removed to accurately determine drug efficacy. After these adjustments, mean weight reductions at 56 weeks (95% CI) were observed for semaglutide, phentermine-topiramate (PT), sibutramine, probiotics, orlistat, metformin and GLP-1 receptor agonists such as liraglutide, exenatide and dulaglutide, with losses of 12.55 (10.17-16.19), 10.16 (8.06-12.30), 5.86 (4.10-7.62), 3.23 (1.11-5.36), 2.66 (2.06-3.28), 2.29 (0.26-4.37), and 1.93 (1.17-2.72) kg, respectively. Drugs took 32.9-47.8 weeks to achieve their efficacy plateau, with GLP-1 receptor agonists acting most rapidly. No significant differences in drug effectiveness were found between children/adolescents and adults for semaglutide, liraglutide, orlistat and high-dose PT (15/92 mg). Notably, low-dose PT (7.5/56 mg) was more effective in the paediatric population. Subgroup analyses indicated that GLP-1 receptor agonists and orlistat were particularly effective in patients with non-metabolic forms of obesity, and drugs were more efficacious in males. 2
CONCLUSIONS: This study provides key quantitative evidence to inform the use of weight-loss medications in treating obesity in the paediatric demograph.
