Add-on naltrexone/bupropion helps shed pounds in patients on incretins

The extended-release fixed-dose combination of naltrexone and bupropion (NB) appears to induce weight loss in obese or overweight patients with type 2 diabetes mellitus (T2DM) receiving treatment with dipeptidyl peptidase 4 inhibitors (DPP-4is) or glucagon-like peptide-1 receptor agonists (GLP1-RAs), according to a post-hoc analysis of the LIGHT trial.

LIGHT included 1,317 participants (mean age 60.7 years, 55.1 percent female, mean body mass index 37.5 kg/m²), of which 737 (56 percent) achieved at least a 2-percent weight loss at week 16.

Compared with placebo, NB conferred significantly larger weight loss over 52 weeks. The mean percent weight change from baseline was −5.5 percent with NB vs −0.9 percent with placebo (treatment difference, −4.6 percent; p<0.0001) in the DPP-4i subgroup, and −4.9 percent with NB vs 0.3 percent with placebo (treatment difference, −5.2 percent; p<0.0001) in the GLP-1RA subgroup.

The number of patients who achieved 5 percent weight loss was likewise much greater with NB vs placebo at weeks 26 and 52 in both the DPP-4i and GLP-1RA subgroups. The effect was similar between NB plus DPP-4i and NB plus GLP-1RA or between placebo plus DPP-4i and placebo plus GLP-1RA in any of the analyses.

Serious adverse events occurred in 9.1 percent of the patients on placebo plus DPP-4i, 11.1 percent of those on placebo plus GLP-1RA, 13.3 percent of those on NB plus DPP-4i, and 12.4 percent of those on NB plus GLP-1RA.

The findings show NB is effective for weight loss among diabetic patients taking incretin agents.