Earlier this week, the Journal of the American Medical Association (JAMA) published a study by Dr. Rohan Khera, graduating resident, and Dr. Siddharth Singh, a former resident at the University of Iowa and current postdoctoral fellow at the University of California, San Diego. They performed a rigorous comparison of five FDA-approved obesity drugs and ranked their effectiveness. Their results have generated no small amount of attention from the Los Angeles Times and LiveScience. The Department asked Dr. Khera for a little more information about this important study and the impressive publication.
—How did you become involved in this study? What was your role?
I had been interested in the question for a while, and put the project together with Dr. Singh who also has an interest in studying obesity and had some experience with conducting studies of this nature. I served as the co-Principal investigator and was involved at every step. Sid (Dr. Singh) helped contact other co-investigators to develop a group with diverse expertise. With another investigator, I performed a systematic review of the literature, and then identified candidate studies. We then developed a database of study outcomes. I collaborated with statistical experts at Mayo Clinic and performed components of the analysis. I wrote the first draft of the manuscript and was responsible for subsequent revisions.
—What was the most fascinating aspect of the work? What were you surprised by?
I think that the most fascinating aspect was the lack of information in the literature guiding the choice of pharmacologic therapy for obesity. I was surprised that while the drugs, in general, were superior to lifestyle and dietary interventions, they had markedly varying efficacy and safety profiles. It is therefore surprising that despite the scourge of obesity and obesity-related disorders, there are no clear recommendations for the choice of agent and duration of therapy.
—Why do you think an examination of these drugs’ effectiveness against one another hadn’t been done?
While conducting a comparison between these drugs is important for clinical care, the bar for approval of a new weight-loss drug is set at proving effectiveness against a placebo. Therefore, not unexpectedly, clinical trials for these agents, most of which are funded through the industry, are geared towards achieving this goal. Therefore, we had to resort to an indirect approach to assess comparative effectiveness of these agents, mainly to provide some insight into their relative efficacy and their safety. We were also hoping to identify agents that had the highest benefit-to-risk ratio and were best compared in a future head-to-head trial. We hope that our study would generate interest in conducting such a study.
—You are in the final days of your residency. What’s next?
I am headed to UT Southwestern, Dallas, TX for my Cardiology fellowship.