OBJECTIVES : In the Americas the prevalence of obesity and overweight reach 62% in adults. Obesity and obesity-associated comorbidities (Diabetes Mellitus II (DMII), hypertension, dyslipidemia, etc), present a large impact in mortality and morbidity. The use of anti-obesity drugs in addition to diet, exercise and lifestyle modifications have proven effective in reducing weight. The objective of this study was to determine the comparative efficacy of naltrexone/bupropion vs other anti-obesity drugs.

METHODS : The systematic review was performed in Pubmed, Cochrane´s Library, Imbiomed and LILACS until July 23 2019. Only randomized clinical trials were included if they evaluated obese or overweight patients with a reported comorbidity, treated with naltrexone/bupropion, phentermine, phentermine/topiramate, liraglutide, lorcaserine, compared with placebo or another anti-obesity drug. The outcomes were the number of patients that achieved 5 or 10% weight loss. The network meta-analysis (NMA) was performed in R studio using the “gemtc” package. The size effect was estimated by Risk Ratio (RR) and 95% confidence interval (95% CI). A subgroup analysis was performed for patients with DMII or dyslipidemia/hypertension.

RESULTS : 4,516 records were identified, including 19 were included in the NMA. Five studies evaluated naltrexone/bupropion, 4 liraglutide, 2 phentermine, 3 PT, and 5 lorcaserine. All the patients presented comorbidities, the most frequent were dyslipidemia/hypertension (38%) and DMII (23.8%). Naltrexone/bupropion presented similar efficacy with almost all the other drugs in the overall analysis, and subgroup analysis in patients with DMII and dyslipidemia/hypertension as comorbidities, when analyzing number of patients that achieved a 5 or 10% weight loss.

CONCLUSIONS : Naltrexone/bupropion is an efficacy alternative to reduce weight in obese and overweight patients. When compared with other pharmacological agents it presents similar effectiveness.