Background: Being overweight or obese is a growing health concern not just in the United States, but worldwide. In 2009-2010, 2 out of 3 adults are considered overweight or obese, and 1 out of 3 adults are considered obese in the U.S. Overweight and obesity acts as a major risk in cardiovascular diseases, diabetes, cancer, and arthritis, and carries an overwhelming economic burden. With a 5-10% weight loss, patients can benefit from reduced metabolic and cardiovascular risks; however, this is a challenging goal to achieve and maintain. Naltrexone is a medication commonly used for opioid addiction and alcohol dependence, and bupropion is commonly used for depression. Separately, these two medications have been shown to reduce weight weakly; this review aims to evaluate the benefits of naltrexone and bupropion used in combination for weight loss.
Method: An exhaustive literature search using the search engines Medline-OVID, CINAHL, and Web of Science combining keywords naltrexone, bupropion, and weight loss was conducted. Eligible criteria include research with naltrexone and bupropion combination therapy comparing to mono-therapy, other weight loss therapy, or placebo. Only randomized controlled trials (RTC) were selected for maximum validity. Excluded from this analysis were articles with animal subjects or other languages except English. Selected articles were assessed for quality using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE).
Results: Three articles met the criteria and were included in this systematic review. In Greenway et al, enrolled were 419 participants in this randomized, placebo and monotherapy controlled, double blind trial. In general, at week 24, participants in most combination drug groups showed statistically significant weight loss compared to monotherapy and placebo. In the COR-I study, 1742 participants enrolled in this randomized, double blind, placebo controlled phase 3 trial. At week 56, mean change in body weight was statistically significant in combination drug groups compared to placebo. In the COR-II study, a randomized, double blind, placebo controlled study of 1,496 participants, the combination drug group achieved and maintained weight loss at a more pronounced rate than placebo group at the completion of the 28 week trial.
Conclusion: Naltrexone and bupropion combination therapy shows promising evidence as a drug therapy for long-term weight loss as evidenced by these studies. While this combination therapy is a safe alternative, further research is needed to assess naltrexone and bupropion combination therapy against other current FDA approved weight loss therapy and its effects on patients with complicated obesity.
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