AGA Clinical Practice Guideline on Pharmacological Interventions for Adults with Obesity
AGA Gastroenterology Journal: Published on November, 2022
In adults, obesity-related complications, such as cardiovascular disease, stroke, type 2 diabetes mellitus (T2DM), nonalcoholic steatohepatitis, obstructive sleep apnea, osteoarthritis, and certain types of cancer (eg, colorectal cancer), have also increased, contributing to high morbidity and mortality.
TAKE-HOME MESSAGE
The American Gastroenterological
Association has released a guideline for the pharmacological management of
obesity in the hopes of supporting providers in decision-making regarding
obesity treatment and boosting their confidence when caring for overweight and
obese adults.
An expert panel developed
recommendations focused on patient-centered outcomes and the current evidence.
In adults with overweight and
obesity who have an inadequate response to lifestyle interventions alone,
long-term pharmacological therapy is recommended, with multiple effective and
safe treatment options.
The panel strongly recommended
pharmacotherapy in conjunction with lifestyle interventions to treat overweight
and obesity in adults, particularly adults for whom lifestyle interventions
alone were inadequate.
Semaglutide, Liraglutide,
Phentermine–Topiramate ER, and Naltrexone–bupropion were recommended based on
moderate certainty evidence.
Phentermine and Diethylpropion were
also recommended; however, the evidence supporting this was of low certainty.
This is especially useful for primary care providers who are on the frontline of treating this increasingly prevalent and harmful disease.
Summary of Recommendations:
American Gastroenterological Association Recommendations on Pharmacological Interventions for Management of Obesity
In adults with obesity or overweight with weight-related complications, who have had an inadequate response to lifestyle interventions.
1. The AGA recommends adding pharmacological agents to lifestyle interventions over continuing lifestyle interventions alone.
The AGA suggests using -
2. Semaglutide 2.4 mg with lifestyle modifications.
3. Liraglutide 3.0 mg with lifestyle modifications.
4. Phentermine-topiramate ER with lifestyle modifications.
5. Naltrexone-bupropion ER with lifestyle modifications.
6. AGA suggests against the use of orlistat.
7. Phentermine with lifestyle modifications.
8. Diethylpropion with lifestyle modifications.
9. In adults with BMI between 25 and 40 kg/m2, the AGA recommends using Gelesis100 oral superabsorbent hydrogel only in the context of a clinical trial.
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Background & aims: Pharmacological
management of obesity improves outcomes and decreases the risk of
obesity-related complications. This American Gastroenterological Association
guideline is intended to support practitioners in decisions about
pharmacological interventions for overweight and obesity.
Methods: A
multidisciplinary panel of content experts and guideline methodologists used
the Grading of Recommendations Assessment, Development and Evaluation framework
to prioritize clinical questions, identify patient-centered outcomes, and
conduct an evidence synthesis of the following agents: semaglutide 2.4 mg,
liraglutide 3.0 mg, phentermine-topiramate extended-release (ER),
naltrexone-bupropion ER, orlistat, phentermine, diethylpropion, and Gelesis100
oral superabsorbent hydrogel. The guideline panel used the evidence-to-decision
framework to develop recommendations for the pharmacological management of
obesity and provided implementation considerations for clinical practice.
Results: The
guideline panel made 9 recommendations. The panel strongly recommended the use
of pharmacotherapy in addition to lifestyle intervention in adults with
overweight and obesity (body mass index ≥30 kg/m2, or ≥27 kg/m2 with
weight-related complications) who have an inadequate response to lifestyle
interventions. The panel suggested the use of semaglutide 2.4 mg, liraglutide
3.0 mg, phentermine-topiramate ER, and naltrexone-bupropion ER (based on
moderate certainty evidence), and phentermine and diethylpropion (based on low
certainty evidence), for long-term management of overweight and obesity. The
guideline panel suggested against the use of orlistat. The panel identified the
use of Gelesis100 oral superabsorbent hydrogel as a knowledge gap.
Conclusions: In adults
with overweight and obesity who have an inadequate response to lifestyle
interventions alone, long-term pharmacological therapy is recommended, with
multiple effective and safe treatment options.
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