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Drug prescriptions

Weight-loss medications under prescribed despite FDA approval

They found that only 1.0% (23,162) of eligible patients filled a prescription for a weight loss medication over the study period
The most commonly prescribed medication was phentermine accounting for 77.3% (160,050) of all prescriptions

Despite guidelines that advocate the use of weight loss medications to treat obesity, and the availability of FDA approved medications, very few patients use this treatment option, according to a study presented at ENDO 2016, the annual meeting of the Endocrine Society, in Boston. More than a third of adults in the US have obesity and lifestyle changes have produced modest weight loss. Although surgery is an effective treatment, it is costly, carries risk and, according to the authors, is only appropriate for a limited number of people.

However, the lead study researchers from University of Colorado and Denver Health Medical Center, state that weight loss medications can be effective, and guidelines suggest obese patients and their doctors should consider their use for selected patients.

Daniel Bessesen (Credit: University of Colorado )

"We looked at how commonly weight loss medications were prescribed to patients for whom guidelines suggest this treatment would be appropriate," said lead author Dr Daniel Bessesen, Professor of Medicine and Chief of Endocrinology at the University of Colorado and Denver Health Medical Center. "It seems that despite the broad realisation that obesity is a problem and that there are available FDA approved medications, few patients use this treatment option."

In the study, ‘Patterns of Prescribing of Weight Loss Medications in a Large Cohort of Adults, the researchers examined prescribing patterns of weight loss medications using data from EHRs in a cohort of 2,262,508 eligible adult patients receiving care over the period of 2009-13, through one of eight integrated care systems in the Patient Outcomes Research to Advance Learning (PORTAL) network. It is one of 13 Patient Centered Outcomes Research Institute (PCORI) funded Clinical Data Research Networks (CDRNs).

Sites within PORTAL participating in this analysis include Kaiser Permanente regions (Northwest, Hawaii, Southern California, Colorado, and Mid-Atlantic States), Group Health Cooperative (Washington), HealthPartners (Minnesota and Wisconsin) and Denver Health.  Subjects were >18 yrs old and had at least one year of continuous membership in their health plan. Data were available on subject’s gender, race, ethnicity, baseline BMI, co-morbid conditions, number of prescriptions filled over the period of observation, prescribing provider and the medication.

They found that only 1.0% (23,162) of eligible patients filled a prescription for a weight loss medication over the study period.  Practice variation was seen with 1.8% of eligible patients receiving a prescription in one system while only 0.4% received a prescription in another. 

The most commonly prescribed medication was phentermine accounting for 77.3% (160,050) of all prescriptions. Diethypropion (16.0%), Phendimetrazine (7.4%) and orlistat (4.5%) were less commonly prescribed.  Marked practice variation was also observed with orlistat accounting for 11.6% of prescriptions filled at one site and only 0.1% of prescriptions at another. 

There was a gradual and steady increase in the number of weight loss prescriptions filled from 37,277 in 2009 to 48,816 in 2013 (the cohort size did not change).

The data suggested patients were not using these medications continuously as there was only an average of 8.9 fills per patient over the four years examined (range 3.7-12.9 across sites).  Prescriptions were written by a total of 3,488 providers. Providers writing 21 or more prescriptions over the period of study accounted for only 30.8% of the total pool of prescribing providers although this group wrote 93.3% of the total number of prescriptions filled. 

They concluded that despite guidelines advocating the use of weight loss medications in obese patients, very few appear to be receiving this treatment option, with a small number of providers write a vast majority of the prescriptions written for these medications. 

"In many other diseases like hypertension and diabetes, treatment with medications is common and considered standard practice," said Bessesen. "There remain many questions about why so few patients use weight loss medications."

The study was supported by the Patient Centered Outcomes Research Institute.

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