The Concept of CMR
Slides, videos and moreManaging CMR
Managing Cardiometabolic Risk in Abdominally Obese Patients
Pharmacotherapy
- 1Key Points (1 page)
- 2Foreword (1 page)
- 3Orlistat (3 pages)
- 4Sibutramine (3 pages)
- 5Rimonabant (4 pages)
- 6Conclusions (1 page)
- 7References (1 page)
Sibutramine
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Figure 3: 
Figure 3: Other trials have assessed the ability of sibutramine to prevent regain of body weight. The two-year Sibutramine Trial of Obesity Reduction and Maintenance provided evidence that sibutramine had a positive effect on weight maintenance after weight loss (29). A selective subgroup of patients who had successfully lost more than 8 kg after six months of taking sibutramine 10 mg/day were randomly assigned to continue sibutramine or switch to placebo. In the 18 months that followed, the placebo-treated patients steadily regained weight, maintaining only 20% of their weight loss after two years. Sibutramine-treated subjects maintained 80% of their initial weight loss after two years.
A one-year trial tested the efficacy of intermittent vs. continuous therapy with sibutramine on weight loss (30). The patients randomized to sibutramine received either continuous treatment (15 mg/day) for one year or were subjected to two six-week periods of sibutramine withdrawal during the one-year treatment. A small weight regain was observed during the two placebo periods, and the weight was lost when the drug was resumed. At the end of the trial, both regimens had lost the same amount of weight.
Because sibutramine enhances satiety, a dietary program that takes advantage of this is likely to spur greater weight loss than the drug alone. This was shown to be the case in a one-year study in which obese adults received sibutramine alone, sibutramine plus regular visits to a physician, intensive group lifestyle modification counselling alone, or sibutramine plus intensive lifestyle modification counselling (31). Those in the sibutramine plus intensive lifestyle modification program lost the most weight, an average of 12.1 kg compared to 5.0 kg with sibutramine alone and around 7 kg with the comprehensive lifestyle modification program alone. This indicates that pharmacological and behavioural interventions have a strong additive effect (Figure 3). Interestingly, subjects who recorded their food intake more frequently lost more than twice as much weight as those who did not (18.1 vs. 7.7 kg). It would not be surprising to find that intensive counselling can improve the efficacy of any weight-reduction drug. Despite differences in the magnitude of weight loss among the four experimental groups (drug alone, drug plus regular visits to physician, intensive lifestyle modification program, and drug plus intensive lifestyle modification program), no difference was found in the response of metabolic and CVD risk variables across the four groups. This is most likely because the sample mainly included obese women who had a normal risk factor profile and were presumably at low risk of CVD.
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