A systematic review found that both semaglutide and mazindol significantly reduce body weight in East Asian people with obesity, but differences in study design prevented a direct comparison between the two drugs.
Only 2 trials foundDespite growing obesity prevalence in East Asia, only 2 qualifying RCTs of anti-obesity medications exist for this population
What the researchers found
Semaglutide (STEP 6) significantly reduced body weight and cardiometabolic risk factors (HbA1c, cholesterol, blood pressure) in Japanese and South Korean patients with obesity. Mazindol also reduced weight and cholesterol in Japan. Direct comparison was not feasible due to study heterogeneity.
Why it matters
East Asians face higher obesity-related health risks at lower BMI levels than Western populations, making effective anti-obesity treatments particularly important in this group. This review establishes the evidence base for the two most relevant medications.
The numbers in context
Asians have higher obesity-related comorbidity risk at lower BMI compared to Europeans; the review highlights this disparity in available drug evidence.
How the study worked
Systematic literature review of Embase, MEDLINE, and ICHUSHI databases for RCTs of semaglutide or mazindol in East Asian adults with obesity. Indirect treatment comparison (ITC) feasibility was assessed based on heterogeneity of effect modifiers and study design variations.
Who was studied
East Asian adults with obesity across multiple clinical studies
What this study cannot tell us
Only 2 studies met inclusion criteria, severely limiting analysis. Semaglutide and mazindol could not be directly compared. English and Japanese language restriction may have excluded some studies. No data on newer GLP-1 agonists (tirzepatide) in East Asian populations at time of review.
How to read the evidence
Moderate evidence — systematic review methodology but limited by only 2 qualifying studies. Indirect treatment comparison was not feasible.
When this study was published
Published in 2024, reflecting the current evidence gap for anti-obesity medications in East Asian populations.
The bigger picture
As the obesity epidemic grows in East Asia, there is an urgent need for evidence specific to this population. The paucity of trials — only 2 qualifying studies found — highlights how underrepresented East Asian patients are in anti-obesity medication research.
Questions still open
- Would tirzepatide show even greater weight loss in East Asian patients, and at what BMI thresholds?
- Should obesity treatment BMI cutoffs be formally lowered for East Asian populations?
- How do the adverse event profiles of semaglutide and mazindol compare specifically in East Asian patients?
Common questions
Why do East Asian people need different obesity research?
Is semaglutide approved for obesity treatment in Japan?
Read the original research
Clinical Efficacy and Safety of Anti-Obesity Medications Among Adult East Asian People with Obesity: A Systematic Literature Review and Indirect Treatment Comparison.
Advances in therapy, 41(9), 3452-3470
Citation
Yokote, Koutaro; Ota, Riku; Wada, Shogo; Matsuda, Hiroyuki; Filomeno, Ronald. (2024). Clinical Efficacy and Safety of Anti-Obesity Medications Among Adult East Asian People with Obesity: A Systematic Literature Review and Indirect Treatment Comparison.. Advances in therapy, 41(9), 3452-3470. https://doi.org/10.1007/s12325-024-02941-7