Tirzepatide Facilitates Greater Weight Loss, Strongest Antihypertensive Effects
For weight loss and antihypertensive effects on systolic and diastolic blood pressure, semaglutide also had increased effects.
Tirzepatide (Mounjaro, Zepbound) showed the greatest weight loss and strongest antihypertensive effects among popular anti-obesity medications, according to results of a study published in eClinicalMedicine.1
All pharmacotherapies did reduce body weight, with tirzepatide reducing weight loss the most, followed by semaglutide. | Image Credit: Douglas | stock.adobe.com
However, the investigators noted that, “Regarding adverse event risks, most weight loss medications are associated with an increased risk of discontinuation due to adverse events, with tirzepatide presenting the highest risk.”1
From 1971 to 1980, there was only a small rise of approximately 0.5% in the prevalence of obesity in the United States. This was followed by a rapid increase for at least 20 years. The prevalence rose to 23.3% in 1988 to 1994 and 30.9% in 1999 to 2000 for Americans aged 20 to 74 years. From 1999 to 2016, the prevalence continued to rise, according to authors of a review published in Nutrients.2
Overweight and obesity are considered chronic conditions, which can be caused by many factors. Specifically, obesity has been known to increase the risk of heart diseases, type 2 diabetes, and cancer. Although lifestyle changes can reduce weight, sometimes pharmaceutical interventions are needed.3 Recently, glucagon-like peptide-1 (GLP-1) receptor agonists have been found to reduce blood sugar, promote weight loss, and provide kidney and cardiac protection. GLP-1 medications are also used as an adjunct to lifestyle changes.4
Investigators of the current study evaluated effects of weight loss medications across impacts on weight loss, cardiometabolic health, psychological outcomes, and adverse events for individuals with overweight or obesity. The authors aimed to use evidence-based data for weight management in clinical practice.1
Investigators conducted a search of PubMed, Web of Science, and the Cochrane Central Register of Controlled Trials for articles published up to June 8, 2024. Efficacy end points included body weight, body mass index, weight circumference, body fat percentage, cardiovascular and metabolic indications, and mental health indicators. For safety, end points included the occurrence of any adverse events, serious adverse events, and system-specific adverse reactions.1
There were 5864 articles identified, but only 154 full-text reviews were included. There were 112,515 individuals with overweight and obesity included, with 5.6% of individuals having simple overweight/obesity, 92.4% had body weight-related complications and comorbidities, and 2% had psychiatric disorders related to overweight/obesity. Treatment for patients included tirzepatide for 5.8% of patients, semaglutide (Ozempic, Wegovy) for 23.9%, liraglutide (Victoza, Saxenda) for 25.2%, orlistat (Xenical) for 10.3%, naltrexone/bupropion (Contrave) for 24.3%, phentermine/topiramate (Qsymia) for 4.3%, naltrexone (Vivitrol) for 0.2%, bupropion (Wellbutrin, Zyban) for 0.8%, phentermine (Adipex) for 0.6%, and topiramate (Topamax, Topiragen) for 4.6%.1
Investigators found that all pharmacotherapies did reduce body weight, with tirzepatide reducing weight loss the most, followed by semaglutide. The 3 lowest weight loss reductions were found for topiramate, phentermine, and bupropion. The combination therapies also showed superior weight loss compared to the monotherapies. Tirzepatide also showed the largest reductions in body weight percentage and weight circumference, also followed by semaglutide.1
Tirzepatide also had the strongest antihypertensive effects on both systolic and diastolic blood pressure, followed by semaglutide. Tirzepatide also had the most substantial improvements in triglyceride and high-density lipoprotein cholesterol and the largest reductions in fasting glucose and glycated hemoglobin A1C. Naltrexone/bupropion, naltrexone, and bupropion increased both systolic and diastolic blood pressure. Additionally, phentermine had the greatest reduction in total cholesterol, followed by tirzepatide.1
Additionally, orlistat had a significant lipid-lowering effect, and semaglutide did not reduce total cholesterol or low-density lipoprotein levels. For psychological aspects, tirzepatide had the greatest improvements in Impact of Weight on Quality of Life-Lite total scores, followed by semaglutide. Topiramate increased the incidence of depression, and bupropion decreased beck depression inventory depression scores. Further, naltrexone/bupropion and phentermine/topiramate increased anxiety, and phentermine/topiramate increased irritability. Liraglutide and phentermine/topiramate also increased the incidence of sleep disorders.1
None of the medications increased the risk of serious adverse events, but naltrexone/bupropion, orlistat, semaglutide, liraglutide, topiramate, phentermine/topiramate, and tirzepatide were associated with higher discontinuation rates due to adverse events. Tirzepatide had the highest risk of discontinuation. Furthermore, the GLP-1 medications had the highest association with gastrointestinal disorders.1
“These findings provide valuable guidance for personalized weight management and may help improve health and reduce the risk of all-cause or cardiovascular mortality in individuals living with overweight or obesity,” investigators concluded. 1
READ MORE: Obesity Management Resource Center
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