1. Chandy Lou P. Malong, MD & John S. Delgado, MD
Efficacy of Orlistat versus Placebo in the Improvement of Lipid Profile Among Overweight and Obese Patients: A Meta-analysis
Chandy Lou P. Malong, MD & John S. Delgado, MD 1

2. Introduction
increase of 4.5% in hypercholesterolemia from the previous prevalence rate of 4% (6th National Nutrition Health Survey )
inhibitor of pancreatic, gastric, and carboxylesterlipase
blocks absorption of cholesterol and triacylglycerols
systemic effect facilitates weight loss in obese subjects
weight loss in overweight persons associated with an improvement in the serum lipid profile
Pi-Sunyer FX. A review of long-term studies evaluating the efficacy of weight loss in ameliorating disorders
associated with obesity. Clin Ther 1996;18:
Goldstein DJ. Beneficial health effects of modest weight loss. Int J Obes Relat Metab Disord 1992;6:

3. Objectives
To determine, through a meta-analysis, the efficacy of Orlistat compared with placebo in lowering lipid levels among overweight and obese patients with or without other comorbidities

4. Methodology MEDLINE, HERDIN, Cochrane, ScienceDirect, Manual searching
RCTs: Orlistat 120mg/tab TID vs Placebo on Lipid Profile among Overweight and Obese reported as Mean Change from Baseline
58 Journals to 7 RCTs
PEDro Rating Scale
REVMAN 5.0: mean change in TC, LDL-C, HDL-C, and TG

5. Author
Duration P
BMI
WEIGHT
AGE
% M TC
LDL
HDL TG
COMORBID
Litonjua, et al 2004
14 wk ^~
O: 300
P: 286
O:30.83 ±4.53
P:30.37 ±4.38
O:77.45 ±13.87
P:75.82 ±14.22
O:38.79 ±10.37
P:39.98 ±10.52
O:33.3
P:29
O:6.26 ±0.92
P:6.33 ±0.9
O:4.35 ±0.82
P:4.35 ±0.75
O:1.19 ±0.31
P:1.23 ±0.35
O:1.7 ±0.88
P:1.71 ±0.99
Metabolic Syndrome
Lindgarde, et al 2000
1y*^~
O: 190
P: 186
O:33.2 ±3
P:33.2 ±3.1
O:96.1 ±13.7
P:95.9 ±13.5
O:53.7 ±9.4
P:53.3 ±9.9
O:34.7
P38.2
O:6.15 ±1.21
P:6.06 ±1.19
O:3.75 ±1.38
P:3.66 ±1.41 NR
Type 2 diabetes
Hypertension
Kelley, et al 2002
1y^~
O: 266
P: 269
O:35.8 ±3.26
P:35.6 ±4.92
O:102 ±16.31
P101.8 ±116.4
O:57.8 ±8.15
P:58 ±8.2
O:43.6
P43.9
O:5.49 ±0.07
P:5.43 ±0.07
O:3.37 ±0.06
P:3.3 ±0.06
O:1.07 ±0.02
P:1.07 ±0.02
O:2.33 ±0.1
P:2.31 ±0.08
Diabetes, treated with insulin
Finer, et al 2000
48wk**^~
O: 110
P: 108
O: 36.8 ±3.6
P:36.8 ±3.7
O: 97.9 ±12.9
P: 98.4 ±15
O: 41.5 ±10.5
P: 41.4 ±10
O:10.9
P:12
O:5.64 ±0.95
P:5.62 ±0.95
O:3.67 ±0.84
P: 3.67 ±0.85
O:1.22 ±0.28
P:1.22 ±0.29
None
Muls, et al 2001
24wk*^~
O: 147
P: 143
O:32.9 ±3.5
P:33.0 ±3.7
O:88.9 ±13.6
P:89.8 ±14.4
O:49.6 ±10
P:47.5 ±11
O:18.4
P:20.3
O:7.33 ±0.74
P:7.28 ±0.77
O:5.09 ±0.61
P:5.03 ±0.68
O:1.45 ±0.35
P:1.49 ±0.37
O:1.71 ±0.68
P:1.65 ±0.62
Hollander, et al 1998
1y***^~
O:162
P:159
O:34.5 ±3.2
P:34 ±3.4
O:99.6 ±14.5
P:99.7 ±15.4
O:55.4 ±8.8
P:54.7 ±9.7
O:48.8
P:53.5
Hill, et al 1999
1y****^~
O: 87
P: 102
O:32.8 ±0.2
P: 32.8 ±0.2
O: 89.7 ± 0.9
P: 90.8 ± 0.9
O: ± 0.7
P: ± 0.7

6. Total Cholesterol

7. Low Density Lipoprotein

8. High Density Lipoprotein

9. Triglyceride

10. Discussion
Cholesterol is absorbed by becoming incorporated into mixed micelles
Inhibition of fat digestion prevents micelle formation, and therefore, cholesterol absorption
Majority of the indication for Orlistat use is for weight reduction.
Most studies show improvement in other cardiovascular risk factors different from body weight, including lipid profile
No statistically significant change in HDL-C level
Factors that may have an effect on HDL:
duration of the Orlistat treatment
change in initial HDL-C was observed only during the active weight loss
Smoking

11. Conclusion Impact to Clinical Practice
Orlistat produces statistically significant improvement in TC, LDL-C, TG levels in overweight and obese patients
This study has established the lipid-lowering effect of Orlistat with the known benefits of weight reduction.
Orlistat can be indicated for the treatment of hypercholesterolemia, hyper-LDLipidemia, and hypertriglyceridemia in addition to obesity management
Impact to Research
Effect of Orlistat in improving Lipid Profile independent of weight loss
Whether Orlistat can be used as an adjunct to standard lipid-lowering agents particularly among high risk patients

12. Chandy Lou P. Malong, MD & John S. Delgado, MD
Efficacy of Orlistat versus Placebo in the Improvement of Lipid Profile Among Overweight and Obese Patients: A Meta-analysis
Chandy Lou P. Malong, MD & John S. Delgado, MD 12

13. Physiotherapy Evidence Database (PEDro) scale
Subjects were randomly allocated to groups (in a crossover study, subjects were randomly allocated an order in which treatments were received)
Allocation was concealed
The groups were similar at baseline regarding the most important prognostic indicators
There was blinding of all subjects
There was blinding of all therapists who administered the therapy
There was blinding of all assessors who measured at least one key outcome
Measures of at least one key outcome were obtained from more than 85% of the subjects initially allocated to groups
All subjects for whom outcome measures were available received the treatment or control condition as allocated or, where this was not the case, data for at least one key outcome was analyzed by “intention to treat”
The results of between-group statistical comparisons are reported for at least one key outcome
The study provides both point measures and measures of variability for at least one key outcome
**Eligibility criteria were specified

14. Physiotherapy Evidence Database (PEDro) scale
Criteria 1 2 3 4 5 6 7 8 9 10
Eligibility
Score
Finer, et al6 √
Hill, et al7
Hollander, et al8
Kelley, et al9
Lindgarde, et al10
Litonjua, et al11
Muls, et al12