pharmacotherapy

Obesity Management Pharmacotherapies and Lifestyle Treatment for Pediatric Obesity Management A Systematic Review and Network Meta-Analysis

Nathan Hinkle — Wed, 09 Sep 2026 05:00:00 +0000

Date Added:

September 9, 2026

Journal/Publication:

JAMA Pediatrics

Publisher:

The American Medical Association

Publication Date:

June 22, 2026

Issue:

Volume:

180

Pages:

961-974

URL:

Obesity Management Pharmacotherapies and Lifestyle Treatment for Pediatric Obesity Management A Systematic Review and Network Meta-Analysis

Type:

Meta-analyses, Reviews, and Guidelines, Community-Based Research Results

Format:

Article

DOI (1):

doi:10.1001/jamapediatrics.2026.2248

Keywords

pediatric obesity

pharmacotherapy

meta-analysis

MeSH

Pediatric Obesity* / prevention & control

body mass index

RPR Commentary: A review of the evidence regarding management of obesity in children . James W. Mold, MD, MPH

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Abstract
Importance Pediatric obesity is a global health challenge. Although health behavior and lifestyle treatment (HBLT) is foundational, the comparative effectiveness of HBLT, various pharmacotherapies, and their combinations remains unclear.

Objective To compare the effectiveness of obesity management pharmacotherapies, structured lifestyle treatment, and their combinations on weight management outcomes in children and adolescents living with obesity.

Data Sources A systematic search was conducted in 4 electronic databases (Embase, CENTRAL, PsycINFO, and PubMed) from inception to June 17, 2025.

Data Selection Randomized clinical trials (RCTs) involving children and adolescents (aged 10-19 years) with obesity were selected. Interventions included lifestyle treatment (HBLT and counseling), obesity management pharmacotherapies (glucagon-like peptide-1 receptor agonists, metformin, orlistat, phentermine topiramate), or their combination vs control.

Data Extraction and Synthesis Data were extracted and validity assessed according to PRISMA guidelines. A random-effects network meta-analysis was used to pool data. Meta-regression was used to explore outcome moderators.

Main Outcomes and Measures Primary outcomes were body mass index (BMI; calculated as weight in kilograms divided by height in meters squared) and BMI z score; secondary outcomes included waist circumference (WC), fat mass (FM), and lean mass (LM).

Results A total of 42 RCTs with 3835 participants (median [IQR] age, 14.5 [13.3-15.1] years; 2270 female [59.2%]) were included. Treatments combining pharmacotherapy and lifestyle treatment demonstrated the greatest efficacy across all adiposity-related outcomes. Semaglutide plus counseling was associated with the largest BMI reduction (mean difference, −8.31; 95% CI, −12.33 to −4.28) and BMI z score reduction (mean difference, −1.80; 95% CI, −2.39 to −1.21), although this estimate was based on a limited number of studies. All pharmacological treatments were more effective when paired with lifestyle treatment, associated with significantly greater BMI and BMI z score reductions than the same medications alone. Based on the primary analysis, HBLT as monotherapy was associated with substantial decreases in BMI (mean difference, −3.85; 95% CI, −4.91 to −2.80) and BMI z score (mean difference, −0.89; 95% CI, −1.17 to −0.61) vs control.

Conclusions and Relevance Finding of this systematic review and network meta-analysis suggest that combining lifestyle treatment with obesity management medications was associated with the greatest short-term (typically 6 to 12 months) weight reduction in adolescents with obesity. HBLT remained an indispensable component of any effective weight management, delivering meaningful weight loss and healthier body composition on its own. Combined with lifestyle treatment, pharmacotherapy was a key component, not solely an adjunct, associated with the greatest BMI and BMI z score improvements, and long-term sustainability and safety were monitored.

Author/s:

Ke-wen Wan, Evander Fung-chau Lei, Ying Liu, Asefa Adimasu Taddese, Patrick lp, Gabriel Torbahn, Daniel Weghuber, Wendy Y. Huang, Bjorn T.Tam

Pharmacologic Treatment of Heart Failure With Reduced Ejection Fraction: An Updated Systematic Review and Network Meta-Analysis

Megan George — Tue, 04 Nov 2025 16:02:16 +0000

Date Added:

November 4, 2025

Journal/Publication:

JACC

Publication Date:

August 29, 2025

URL:

Pharmacologic Treatment of Heart Failure With Reduced Ejection Fraction: An Updated Systematic Review and Network Meta-Analysis

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1016/j.jacc.2025.08.054

Keywords

HFrEF

drug therapy

pharmacotherapy

PMID (1):

40892608

MeSH

Mineralocorticoid Receptor Antagonists

Network Meta-Analysis

Death

Sudden

Death, Sudden, Cardiac

This large meta-analysis confirms the substantial life extension conferred by aggressive, four drug treatment of CHF with reduced EF. James W. Mold, MD, MPH

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Background: In 2022, a network meta-analysis showed that a combination of β-blockers, angiotensin receptor-neprilysin inhibitors (ARNi), mineralocorticoid receptor antagonists (MRAs), and sodium-glucose cotransporter 2 inhibitors (SGLT2i) was most effective in reducing all-cause mortality in heart failure with reduced ejection fraction (HFrEF). This study updates the treatment benefit by including additional large randomized controlled trials (RCTs) since 2022, including the VICTOR (Vericiguat Global Study in Participants with Chronic Heart Failure) trial.

Objectives: The goal of this study was to evaluate and compare regimens of pharmacotherapy in patients with HFrEF.

Methods: MEDLINE, Embase, and Cochrane Central Register of Controlled Trials databases were searched for RCTs in patients with HFrEF through April 2025. Using frequentist network meta-analysis, HRs for all-cause mortality (primary outcome), cardiovascular death, and the composite of cardiovascular death or heart failure hospitalization (secondary outcomes) were estimated. Absolute benefits were quantified as life-years gained by using BIOSTAT-CHF (Biology Study to Tailored Treatment in Chronic Heart Failure) and ASIAN-HF (Asian Sudden Cardiac Death in Heart Failure) cohort data.

Results: The analysis included 103,754 patients across 89 randomized controlled trials. Relative to placebo, quintuple therapy with ARNi, β-blockers, MRAs, SGLT2i, and vericiguat most effectively reduced all-cause mortality (HR: 0.35; 95% CI: 0.27-0.45), followed by quadruple therapy with ARNi, β-blockers, MRAs, and SGLT2i (HR: 0.39; 95% CI: 0.32-0.49). For a representative 70-year-old patient, quadruple therapy (ARNi/β-blockers/MRAs/SGLT2i) provided 5.3 additional life-years (95% CI: 2.8-7.7) vs no treatment, while quintuple therapy (ARNi/β-blockers/MRA/SGLT2i/vericiguat) provided 6.0 additional life-years (95% CI: 3.7-8.4).

Conclusions: This analysis reinforces the substantial mortality and morbidity benefit associated with the currently recommended quadruple therapy regimen (ARNi, β-blockers, MRAs, and SGLT2i) in patients with HFrEF. The addition of vericiguat may provide an incremental survival gain of approximately 0.7 year beyond that achieved with quadruple therapy. However, these results should be regarded as exploratory, as they are derived from a secondary endpoint of a single trial.

Keywords: HFrEF; drug therapy; pharmacotherapy.

Author/s:

Bart J. van Essen, Daan C.H. Ceelen, Wouter Ouwerkerk, Tiew-Hwa K. Teng, Ganash N. Tharshana, Fook Ming Hew, Javed Butler, Faiez Zannad, Carolyn S. Lam, Justin Ezekowitz, Adriaan A. Voors, Jasper Tromp

Identifying and quantifying potentially problematic prescribing cascades in clinical practice: A mixed-methods study

Alex Haga — Tue, 17 Dec 2024 19:30:20 +0000

Date Added:

December 17, 2024

Journal/Publication:

J Am Geriatr Soc

Publication Date:

September 20, 2024

Issue:

Volume:

Pages:

3681-3694

URL:

Identifying and quantifying potentially problematic prescribing cascades in clinical practice: A mixed-methods study

Type:

Clinical Research Results

Format:

Article

DOI (1):

10.1111/jgs.19191

Keywords

adverse drug reaction

appropriate prescribing

pharmacotherapy

prescribing cascades

prescription sequence symmetry analysis

PMID (1):

39305008

MeSH

aged

Aged, 80 and over

Drug Prescriptions/statistics & numerical data

Inappropriate Prescribing / statistics & numerical data

Practice Patterns

Physicians'* / statistics & numerical data

A study that documents many of the common prescribing cascades involving older patients. James W. Mold, MD, MPH

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Background: A prescribing cascade occurs when medication causes an adverse drug reaction (ADR) that leads to the prescription of additional medication. Prescribing cascades can cause excess medication burden, which is of particular concern in older adults. This study aims to identify and quantify potentially problematic prescribing cascades relevant for clinical practice.

Methods: A mixed-methods study was conducted. First, prescribing cascades were identified through literature search. An expert panel (n = 16) of pharmacists and physicians assessed whether these prescribing cascades were potentially problematic. Next, a cohort study quantified potentially problematic prescribing cascades in adults using Dutch community pharmacy data for the period 2015-2020. Additionally, the influence of multiple medications potentially causing the same ADR was evaluated. Prescription sequence symmetry analysis was used to calculate adjusted sequence ratios (aSRs), adjusting for temporal prescribing trends. An aSR >1.0 indicates the occurrence of a prescribing cascade. In a subgroup analysis, aSRs were calculated for older adults.

Results: Seventy-six prescribing cascades were identified in literature and three were provided by experts. Of these, 66 (83.5%) were considered potentially problematic. A significant positive aSR for the medication sequence was found for 41 (62.1%) of these prescribing cascades. The highest aSR was found for amiodarone potentially causing hypothyroidism treated with thyroid hormones (4.63 [95% confidence interval 4.40-4.85]), based on 565 incident users. The biggest population (n = 34,645) was found for angiotensin converting enzyme-inhibitors potentially causing urinary tract infections treated with antibiotics. Regarding four potential ADRs, the aSRs were higher for people using multiple medications that cause the same ADR as compared to people using only one of those medications. Among older adults the aSRs remained significant for 37 prescribing cascades.

Conclusion: An overview was generated of potentially problematic prescribing cascades relevant for clinical practice. These results can support healthcare providers to intervene and reduce medication burden for older adults.

Author/s:

Atiya K Mohammad, Jacqueline G Hugtenburg, Joost W Vanhommerig

Management of Chronic Heart Failure with Reduced Ejection Fraction

Alex Haga — Tue, 20 Aug 2024 20:11:08 +0000

Date Added:

August 20, 2024

Journal/Publication:

The Journal of the American Board of Family Medicine

Publication Date:

May 1, 2024

Issue:

Volume:

Pages:

364-371

URL:

Management of Chronic Heart Failure with Reduced Ejection Fraction

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.3122/jabfm.2023.230436R1

Keywords

heart failure

Reduced Ejection Fraction

CHF

pharmacotherapy

HFrEF

PMID (1):

39142870

MeSH

Heart Failure* / drug therapy

Heart Failure* / diagnosis

Mineralocorticoid Receptor Antagonists* / therapeutic use

Sodium-Glucose Transporter 2 Inhibitors / therapeutic use

Aminobutyrates / therapeutic use

Angiotensin Receptor Antagonists* / therapeutic use

Valsartan

A review of the management of CHF with reduced ejection fraction. James W. Mold, MD, MPH

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Heart failure with reduced ejection fraction (HFrEF) is a commonly seen clinical entity in the family physician's practice. This clinical review focuses on the pharmacologic management of chronic HFrEF. Special attention is paid to the classification of heart failure and the newest recommendations from the American Heart Association concerning the use of guideline-directed medical therapy. β blockers, ACE inhibitors, ARBs, mineralocorticoid receptor antagonists are discussed in detail. The new emphasis on sacubitril-valsartan and SGLT2i's as therapies for HFrEF are reviewed, followed by a brief discussion of more advanced therapies and comorbidity management.

Author/s:

Brandon Williamson, Carl Tong

Evidenced-Based Pharmacotherapies for Alcohol Use Disorder

John Bayhi — Thu, 21 May 2020 16:22:32 +0000

Date Added:

May 21, 2020

Journal/Publication:

Mayo Clinic Proceedings

Publisher:

Elsevier Inc / Mayo Foundation for Medical Education and Research

Publication Date:

May 20, 2020

Volume:

Article in Press

URL:

Evidenced-Based Pharmacotherapies for Alcohol Use Disorder

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1016/j.mayocp.2020.01.030

Keywords

MeSH

Pharmacogenomic Testing

united states food and drug administration

A review of pharmacological approaches to the treatment of alcoholism with some clinical pearls from Mayo physicians. James W. Mold, MD, MPH

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Pathologic alcohol use affects more than 2 billion people and accounts for nearly 6% of all deaths worldwide. There are three medications approved for the treatment of alcohol use disorder by the US Food and Drug Administration (FDA): disulfiram, naltrexone (oral and long-acting injectable), and acamprosate. Of growing interest is the use of anticonvulsants for the treatment of alcohol use disorder, although currently none are FDA approved for this indication. Baclofen, a γ-aminobutyric acid B receptor agonist used for spasticity and pain, received temporary approval for alcohol use disorder in France. Despite effective pharmacotherapies, less than 9% of patients who undergo any form of alcohol use disorder treatment receive pharmacotherapies. Current evidence does not support the use of pharmacogenetic testing for treatment individualization. The objective of this review is to provide knowledge on practice parameters for evidenced-based pharmacologic treatment approaches in patients with alcohol use disorder.

Author/s:

Fairbanks, J, Umbreit, A, Kolla, BP, Karpyak, VM, Schneekloth, TD, Loukianova, LL, Sinha, S

Pharmacotherapy for Adults With Alcohol Use Disorder (AUD) in Outpatient Settings

Tracy Ashby — Fri, 07 Dec 2018 06:00:00 +0000

Date Added:

December 7, 2018

Journal/Publication:

AHRQ Comparative Effectiveness Reviews

Publisher:

Agency for Healthcare Research and Quality

Publication Date:

February 16, 2016

URL:

Pharmacotherapy for Adults With Alcohol Use Disorder (AUD) in Outpatient Settings

Type:

Meta-analyses, Reviews, and Guidelines, Meta-analyses, Reviews, and Guidelines

Format:

Article

Keywords

alcohol use disorder

pharmacotherapy

patient care

PMID (1):

26937549

MeSH

alcoholism

caregivers

decision making

This is a summary of the current evidence on medication-assisted treatment of alcohol use disorder.

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This is a summary of a systematic review evaluating the evidence regarding the efficacy, comparative effectiveness, and adverse effects of medications in adults with alcohol use disorder (AUD). The systematic review included 167 articles reporting on 135 eligible studies published from January 1, 1970, to October 11, 2013. This summary is provided to inform discussions with patients and/or caregivers of treatment options and to assist in decisionmaking along with consideration of a patient's values and preferences. However, reviews of evidence should not be construed to represent clinical recommendations or guidelines.

Author/s:

John M. Eisenberg Center for Clinical Decisions and Communications Science