Antiobesity Drug Prescribing Rates Low and Stagnant

Miriam E Tucker

November 13, 2017

WASHINGTON, DC — Fewer than one in 50 people in the United States eligible for antiobesity medications are receiving them, new data suggest.

The findings, from electronic records of 2.2 million eligible patients in eight large healthcare organizations, were presented November 2 at Obesity Week 2017 by University of Colorado, Aurora, endocrinologist David R Saxon, MD.

The results reveal that among those eligible for weight-loss medications (ie, those who have a body mass index [BMI] ≥30 kg/m2 or ≥27 kg/m2 with weight-related comorbidities), just 1.3% had received a prescription for any weight-loss medication from 2009 to 2015.

And, among those who had, 85% of the prescriptions were for phentermine rather than newer agents, even as recently as 2015.

And the specialists most likely to prescribe these agents are primary-care providers, who represent almost 85% of those writing such scrips.  

Yet surveys have revealed that patients are interested in weight-loss drugs, Dr Saxon told Medscape Medical News. "They want more information from their physicians about these medication options but there's rarely the conversation....Patients are probably more interested in them than the 1.3% who are receiving them."

He acknowledged that it's not yet clear how effective the newer drugs may be in the long term and there still may be real-world safety concerns. Nonetheless, "We have FDA-approved effective interventions that could be more widely disseminated."

Asked to comment, Scott Kahan, MD, director, National Center for Weight and Wellness, and medical director, Strategies To Overcome and Prevent (STOP) Obesity Alliance at George Washington University, Washington, DC, told Medscape Medical News that these findings are in line with those of other studies over the past few years.

"Few providers follow published clinical guidelines for obesity treatment generally, particularly with respect to prescribing obesity medications, and few eligible patients receive pharmacotherapy."

Reasons, Dr Kahan said, include: lack of insurance coverage — although that has been improving; the fact that physicians historically have received little training in obesity management; and misperceptions about obesity medications, including that they are unsafe, ineffective, or not well-studied.

"These misconceptions are likely a legacy of older medications that had lesser requirements for approval and were likely misused," Dr Kahan observed, adding that now, in fact, "efficacy of the newer meds tends to be quite good, with several approaching 15% weight loss in responding patients, along with the expected improvements in weight-related comorbidities such as diabetes."

More Than 80% of Prescriptions for Weight Loss Drugs Go to Women

The new data come from a number of large healthcare-delivery systems that participate in the Patient Outcomes Research to Advance Learning Network, funded by the Patient-Centered Outcomes Research Institute.

The network comprises about 11 million individuals in nine US states (California, Colorado, Georgia, Hawaii, Minnesota, Maryland, Oregon, Virginia, Washington) and the District of Columbia.

The current study population included 2,248,407 adults who met eligibility criteria for use of weight-loss medications. Of those, just 1.3% (29,984 individuals) had received a prescription for any of the eight FDA-approved weight-loss medications: diethylpropion, orlistat, phendimetrazine, phentermine, lorcaserin (Belviq, Eisai), phentermine-topiramate ER (Qsymia, Vivus), naltrexone-bupropion ER, or liraglutide 3.0 mg (Saxenda, Novo Nordisk),

Of those with weight-loss drug prescriptions, 84% were female. Prescription rates increased with BMI, from just 0.4% for BMI 27 to 29.9 kg/m2 (overweight) to 1.1% for BMI 30 to 34.9 kg/m2 (class 1 obesity) to 2.7% for BMI 35 to 39.9 kg/m2 (class 2 obesity) to 3.4% of those with BMI over 40 kg/m2 (class 3 obesity).

Dr Kahan called that "the one bit of good news in this data.…Patients with severe obesity appear to be more frequently prescribed medications."

A recent study had shown that only 1.3% of patients with BMI >40 received pharmacotherapy (Obes Sci Pract. 2016;2:104-114), so the finding of more than 3% here is "a small but meaningful shift," he said.

Of All Weight-Loss Drugs, Phentermine Is Still #1

Overall, there was a 32.9% increase from 2009 to 2015 in total medication days covered for antiobesity drugs, but no increase in the number of people prescribed them.

Phentermine accounted for 85% of all medication days throughout the study period, with the newest medications accounting for only 1.8% of the total medication days even in 2015, Dr Saxon reported.

Among the patients taking phentermine, 33.8% had been using it for more than a year and another 17.9% for 121 to 360 days.

Scrip Rates Vary by Site, Provider, With PCPs Prescribing Most

There was also quite a bit of variation in prescription rates for eligible patients across the eight participating sites, ranging from 0.6% to 2.9%, despite the fact that a majority of the sites were part of the Kaiser Permanente system, Dr Saxon noted.

And of 3902 total prescribers, nearly 90% of the prescriptions were written by the 9.7% of providers who reported prescribing weight-loss drugs for 21 or more patients.

Most of the prescribers (84%) were primary-care physicians, as were most of the high prescribers (95%). Very few specialists were prescribing the medications to more than 20 patients, he said.

"We need a better understanding of why guideline-recommended antiobesity pharmacotherapy is so infrequently provided…and more data on outcomes and safety of antiobesity medications in clinical practice," Dr Saxon concluded.

Dr Saxon has no disclosures. Dr Kahan consults for Novo Nordisk and Orexigen. 

Obesity Week 2017. November 2, 2017; Washington, DC. Abstract T-OR-2070.

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