Effect of orlistat on plasma lipids and body weight: A systematic review and meta-analysis of 33 randomized controlled trials

- Orlistat is an inhibitor of intestinal lipase promoting body weight reduction, but whose lipid-lowering efficacy is controversial.
- We investigated the efficacy of orlistat on plasma lipids and body weight in a meta-analysis of 33 studies including 9732 participants.
- Orlistat was associated with a slight but significant decrease in body weight, plasma cholesterol and triglyceride concentrations, whereas plasma Lp(a) levels were not affected by orlistat treatment.
- Greater body weight reduction and lower duration of orlistat treatment promoted more consistent plasma total- and LDL-cholesterol lowering.

Orlistat, an inhibitor of intestinal lipase, promotes body weight reduction. The lipid-lowering efficacy of orlistat is controversial and the effect of orlistat-induced body weight reduction on lipid changes has not been explored in meta-regression analyses. A systematic literature search was conducted to identify randomized controlled trials investigating the efficacy of orlistat on plasma total, low-density lipoprotein and high-density lipoprotein cholesterol, triglycerides and lipoprotein(a) levels. Thirty-three studies were included in the meta-analysis (5522 and 4210 participants in the orlistat therapy and control groups, respectively). Orlistat reduced body weight (weighted mean difference: −2.12, p < 0.001), total-cholesterol (weighted mean difference: −0.30 mmol/L, p < 0.001), low-density lipoprotein cholesterol (weighted mean difference: −0.27 mmol/L, p < 0.001), high-density lipoprotein cholesterol (weighted mean difference: −0.034 mmol/L, p < 0.001) and triglyceride (weighted mean difference: −0.09 mmol/L, p < 0.001) concentrations, while no effect on lipoprotein(a) was observed. Total- and low-density lipoprotein cholesterol-lowering were associated negatively with duration of orlistat treatment and positively with body weight changes. In conclusion, Orlistat treatment slightly reduces cholesterol and triglyceride levels, but not lipoprotein(a) levels. Total- and low-density lipoprotein cholesterol levels reductions are more consistent in patients with greater body weight reduction and shorter duration of orlistat treatment.

91