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- Title
Pharmacological interventions for the management of children and adolescents living with obesity—An update of a Cochrane systematic review with meta‐analyses.
- Authors
Torbahn, Gabriel; Jones, Andrew; Griffiths, Alex; Matu, Jamie; Metzendorf, Maria‐Inti; Ells, Louisa J.; Gartlehner, Gerald; Kelly, Aaron S.; Weghuber, Daniel; Brown, Tamara
- Abstract
Summary: Importance: The effectiveness of anti‐obesity medications for children and adolescents is unclear. Objective: To update the evidence on the benefits and harms of anti‐obesity medication. Data Sources: Cochrane CENTRAL, MEDLINE, ClinicalTrials.gov and WHO ICTRP (1/1/16–17/3/23). Study Selection: Randomized controlled trials ≥6 months in people <19 years living with obesity. Data Extraction and Synthesis: Screening, data extraction and quality assessment conducted in duplicate, independently. Main Outcomes and Measures: Body mass index (BMI): 95th percentile BMI, adverse events and quality of life. Results: Thirty‐five trials (N = 4331), follow‐up: 6–24 months; age: 8.8–16.3 years; BMI: 26.2–41.7 kg/m2. Moderate certainty evidence demonstrated a −1.71 (95% confidence interval [CI]: −2.27 to −1.14)‐unit BMI reduction, ranging from −0.8 to −5.9 units between individual drugs with semaglutide producing the largest reduction of −5.88 kg/m2 (95% CI: −6.99 to −4.77, N = 201). Drug type explained ~44% of heterogeneity. Low certainty evidence demonstrated reduction in 95th percentile BMI: −11.88 percentage points (95% CI: −18.43 to −5.30, N = 668). Serious adverse events and study discontinuation due to adverse events did not differ between medications and comparators, but medication dose adjustments were higher compared to comparator (10.6% vs 1.7%; RR = 3.74 [95% CI: 1.51 to 9.26], I2 = 15%), regardless of approval status. There was a trend towards improved quality of life. Evidence gaps exist for children, psychosocial outcomes, comorbidities and weight loss maintenance. Conclusions and Relevance: Anti‐obesity medications in addition to behaviour change improve BMI but may require dose adjustment, with 1 in 100 adolescents experiencing a serious adverse event.
- Subjects
WEIGHT loss; RESEARCH funding; BODY mass index; DRUG side effects; EVIDENCE gaps; DATA analysis; DISEASE management; META-analysis; BEHAVIOR; DESCRIPTIVE statistics; SYSTEMATIC reviews; MEDLINE; ANTIOBESITY agents; QUALITY of life; QUALITY assurance; TREATMENT effect heterogeneity; HEALTH promotion; CONFIDENCE intervals; OBESITY; COMORBIDITY; PSYCHOLOGY of the sick
- Publication
Pediatric Obesity, 2024, Vol 19, Issue 5, p1
- ISSN
2047-6302
- Publication type
Article
- DOI
10.1111/ijpo.13113