Liraglutide for weight management: a critical review of the evidence

OBJECTIVE To review the efficacy, safety, and clinical applicability of liraglutide for weight management from phase III clinical trials. METHODS A search of the English language literature was performed using PubMed search terms: "liraglutide", "glucagon-like peptide-1 receptor agonist", and "randomized clinical trial". Articles and bibliographies relevant to the subject were reviewed and additional references known to the authors were included. RESULTS Five randomized, placebo-controlled trials of liraglutide for weight management were identified. In addition to recommended diet and physical activity, liraglutide consistently resulted in a 4 to 6 kg weight loss, with a greater proportion of patients achieving at least 5 and 10% weight loss compared with placebo. The most common adverse effects were gastrointestinal and primarily occurred early in the treatment course. Comparative data suggest that weight loss with liraglutide is greater than that seen with orlistat or lorcaserin, but slightly less that seen with phentermine/topiramate. Liraglutide 1.8 mg was recently shown to have cardiovascular benefit in a large outcomes trial; applicability of these results for the 3.0 mg formulation in a more diverse weight loss population at high cardiovascular risk is not currently known. Barriers to real-world clinical use as a first-line agent include gastrointestinal side effects, high cost, and need for injection. CONCLUSIONS Liraglutide helps to induce and sustain weight loss in patients with obesity. Its efficacy is comparable to other available agents but it offers the unique benefit of improved glycemic control. Additional studies are needed to determine its long term efficacy and safety profile.