Systematic review and meta-analysis of the efficacy and safety of amfepramone and mazindol as a monotherapy for the treatment of obese or overweight patients

Authors

  • Rosa Camila Lucchetta Universidade Federal do Paraná; Departamento de Farmácia; Laboratório de Serviços Clínicos e Evidências em Saúde
  • Bruno Salgado Riveros Universidade Federal do Paraná; Departamento de Farmácia; Laboratório de Serviços Clínicos e Evidências em Saúde
  • Roberto Pontarolo Universidade Federal do Paraná; Departamento de Farmácia; Laboratório de Serviços Clínicos e Evidências em Saúde
  • Rosana Bento Radominski Universidade Federal do Paraná; Hospital de Clínicas; Serviço de Endocrinologia e Metabolismo
  • Michel Fleith Otuki Universidade Estadual de Ponta Grossa; Departamento de Ciências Farmacêuticas
  • Fernando Fernandez-Llimos University of Lisbon; Department of Social Pharmacy, Faculty of Pharmacy; Research Institute for Medicines (iMed.ULisboa)
  • Cassyano Januário Correr Universidade Federal do Paraná; Departamento de Farmácia; Laboratório de Serviços Clínicos e Evidências em Saúde

DOI:

https://doi.org/10.6061/clinics/2017(05)10

Keywords:

Obesity, Weight loss, Treatment Outcome, Evidence-Based Practice

Abstract

The aim of this study was to evaluate efficacy and safety of amfepramone, fenproporex and mazindol as a monotherapy for the treatment of obese or overweight patients. A systematic review of primary studies was conducted, followed by a direct meta-analysis (random effect) and mixed treatment comparison. Medline and other databases were searched. Heterogeneity was explored through I2 associated with a p-value. Of 739 identified publications, 25 were included in the meta-analysis. The global evaluation of Cochrane resulted in 19 studies with a high level of bias and six with unclear risk. Due to the lack of information in primary studies, direct meta-analyses were conducted only for amfepramone and mazindol. Compared to placebo, amfepramone resulted in higher weight loss in the short-term (<180 days; mean difference (MD) -1.281 kg; p<0.05; I2: 0.0%; p=0.379) and long-term (≥180 days; MD -6.518 kg; p<0.05; I2: 0.0%; p=0.719). Only studies with long-term follow up reported efficacy in terms of abdominal circumference and 5-10% weight reduction. These results corroborated the finding that the efficacy of amfepramone is greater than that of placebo. Treatment with mazindol showed greater short-term weight loss than that with placebo (MD -1.721 kg; p<0.05; I2: 0.9%; p=0.388). However, metabolic outcomes were poorly described, preventing a meta-analysis. A mixed treatment comparison corroborated the direct meta-analysis. Considering the high level of risk of bias and the absence of important published outcomes for anti-obesity therapy assessments, this study found that the evaluated drugs showed poor evidence of efficacy in the treatment of overweight and obese patients. Robust safety data were not identified to suggest changes in their regulatory status.

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Published

2017-05-01

Issue

Section

Review

How to Cite

Lucchetta, R. C., Riveros, B. S., Pontarolo, R., Radominski, R. B., Otuki, M. F., Fernandez-Llimos, F., & Correr, C. J. (2017). Systematic review and meta-analysis of the efficacy and safety of amfepramone and mazindol as a monotherapy for the treatment of obese or overweight patients. Clinics, 72(5), 317-324. https://doi.org/10.6061/clinics/2017(05)10