Clinical Pharmacy Services, VA Eastern Kansas Healthcare System, Topeka, Kansas.
Pharmacotherapy. 2018 Jan;38(1):19-28. doi: 10.1002/phar.2048. Epub 2017 Nov 17.
To compare the effectiveness of weight-management medications used to assist with weight loss in real-world clinical practice in the Veterans Health Administration (VHA).
Retrospective, multicenter, observational cohort study.
National VA Corporate Data Warehouse.
A total of 66,035 VA patients aged 18 years or older with a body mass index of 25 kg/m or greater who had an initial fill for a study medication (orlistat [6153 patients], phentermine [304 patients], lorcaserin [298 patients], or phentermine-topiramate extended release [233 patients]) or participation in the VA's MOVE! weight-management program with at least three total visits in a clinic coded as a MOVE clinic in the subsequent 24 weeks (59,047 patients) between January 1, 2012, and July 1, 2016.
The primary outcome was the percentage change in weight from baseline to at least 20 weeks or later (i.e., closest weight to 6 months). Secondary outcomes were difference in the percentage of weight loss at 12 and 36 weeks; changes in blood pressure, hemoglobin A , high-density and low-density lipoprotein cholesterol and triglyceride levels; and percentage of patients who achieved at least a 5% and 10% weight loss at 6 months from baseline in each group after at least 20 weeks. For the primary outcome, the percentage decrease in weight from baseline after at least 20 weeks in the lorcaserin, phentermine-topiramate, phentermine, orlistat, and MOVE! groups were 3.6%, 4.1%, 3.6%, 2.1%, and 1.6%, respectively (phentermine-topiramate group vs. MOVE! group, p<0.05). Achievement of at least a 5% weight loss after at least 20 weeks differed significantly among groups, ranging from 26.2% for the MOVE! Program only group to 40.3% for patients in the phentermine-topiramate group.
In the VA population, the effectiveness of four available weight-management medications was similar. Patients receiving phentermine-topiramate had a greater proportion of weight loss after at least 20 weeks compared with those solely enrolled in the VA's MOVE! weight-management program.
比较在退伍军人事务部（VA）的真实临床实践中，用于辅助减肥的体重管理药物的有效性。
回顾性、多中心、观察性队列研究。
国家退伍军人事务部企业数据仓库。
共有 66035 名年龄在 18 岁或以上、体重指数为 25kg/m 或以上的退伍军人事务部患者，他们首次服用研究药物（奥利司他[6153 名患者]、苯丙醇胺[304 名患者]、lorcaserin[298 名患者]或 phentermine-topiramate 缓释[233 名患者]）或参加退伍军人事务部的 MOVE！体重管理计划，在随后的 24 周内（2012 年 1 月 1 日至 2016 年 7 月 1 日），在编码为 MOVE 诊所的诊所中有至少三次总就诊次数。
主要结果是从基线到至少 20 周或更长时间（即最接近 6 个月的体重）的体重变化百分比。次要结果是在 12 周和 36 周时体重减轻的百分比差异；血压、血红蛋白 A、高密度脂蛋白和低密度脂蛋白胆固醇和甘油三酯水平的变化；以及在至少 20 周后至少 6 个月从基线开始，每组至少有 5%和 10%的患者体重减轻的百分比。对于主要结果，在 lorcaserin、 phentermine-topiramate、phentermine、orlistat 和 MOVE！组中，至少 20 周后体重从基线的下降百分比分别为 3.6%、4.1%、3.6%、2.1%和 1.6%（phentermine-topiramate 组与 MOVE！组比较，p<0.05）。至少 20 周后，至少有 5%的体重减轻在各组之间差异显著，范围从仅参加退伍军人事务部 MOVE！体重管理计划的患者的 26.2%到 phentermine-topiramate 组的 40.3%。
在退伍军人事务部人群中，四种可用的体重管理药物的有效性相似。接受 phentermine-topiramate 的患者在至少 20 周后体重减轻的比例高于仅参加退伍军人事务部 MOVE！体重管理计划的患者。
