The aim of this analysis of the XENSOR study was to assess the effect of 2 weight-loss drugs on hepatic serum biomarkers in patients with overweight or obesity and insufficient weight loss (WL) after a lifestyle modification program. A retrospective real-world study (RWS) was conducted comparing the effect of orlistat 120 mg tid and liraglutide (up to 3 mg daily) on liver enzymes in adult patients with BMI > 30 kg/m² (or > 27 kg/m² with at least a weight-related comorbidity) . The primary endpoint was to assess in a multivariate model the differences in ALT and GGT reductions between both drugs over a median follow-up period of 7 months. A secondary endpoint was to study the impact of the amount of WL on both liver enzymes. 400 patients in the group of orlistat (BMI 41.4 kg/m2, ALT 30.1 U/L, GGT 35.7 U/L) , and 100 in the group of liraglutide (BMI 39.7 kg/m2, ALT 27.3 U/L, GGT 29.1 U/L) , were included. WL with liraglutide (−7.7 kg) was significantly greater in comparison with orlistat (−3.3 kg) , p <0.0001. Treatment with both drugs significantly reduced ALT (orlistat −3.8 U/L; liraglutide −5.7 U/L, both p<0.05) . ALT reduction was significantly higher with liraglutide vs. orlistat (adjusted mean difference −3.4 U/L (95% CI −6.5 to −0.2 U/L) . A significant decrease in GGT levels was observed with liraglutide (−5.8 U/L, p<0.0001) , but not with orlistat. Adjusted mean differences in GGT changes between both drugs were not statistically significant. 46% of patients with high ALT levels lowered this enzyme into the normal range at the end of the follow-up, without significant differences between both drugs. When patients were split into 3 groups according to their WL (<5%, 5-10% and >10%) , ALT and GGT reductions were significantly higher in patients with WL>10%.

In summary, in this RWS ALT reductions were significantly greater with liraglutide in comparison with orlistat. The effects of both drugs on ALT and GGT were higher in those patients with clinically relevant WL (>10%) .


J.J.Gorgojo-martinez: Consultant; Mundipharma, Research Support; Novo Nordisk, Speaker's Bureau; Abbott Diabetes, AstraZeneca, Boehringer Ingelheim International GmbH, Lilly Diabetes, Merck Sharp & Dohme Corp., Mundipharma, Novo Nordisk. P.L.Lois chicharro: None. P.J.Ferreira-ocampo: None. S.C.Doejo-marciales: None. S.F.Barra-malig: None. F.Almodovar-ruiz: None.

Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered. More information is available at