Systematic review of influence of ethnicity on efficacy and safety of pharmacotherapy for childhood and adolescent obesity

Childhood and adolescent obesity represent critical global health issues with a rising prevalence and associated cardiometabolic and psychosocial consequences. Pharmacotherapy has emerged as an adjunct treatment to lifestyle modifications in patients with severe obesity or a poor response to behavioral interventions. However, the ethnic and racial variations in drug efficacy and safety remain poorly understood. This systematic review aimed to determine whether ethnicity influences the efficacy and adverse effects of pharmacological treatments for pediatric obesity. A comprehensive literature search was conducted using PubMed, Embase, Scopus, and Cochrane Library databases for studies published between January 2000 and December 2024. Eligible randomized controlled trials included participants aged ≤18 years and reported ethnicity-specific outcomes for antiobesity pharmacotherapy. Of the 3,979 identified records, 4 randomized trials met the inclusion criteria and investigated liraglutide, metformin, phentermine/topiramate, and sibutramine. Across all studies, pharmacotherapy significantly reduced body mass index compared with placebo. This review provides a complete and clearly articulated conclusion reflecting these findings. However, consistent evidence is lacking of ethnicity-based differences in efficacy or safety. One trial suggested a possible trend of reduced responses among African American adolescents receiving sibutramine, although the findings were underpowered and exploratory. Common limitations include minority group underrepresentation, small subgroup sizes, heterogeneous outcome measures, and post hoc analyses of ethnicity. The risk of bias across trials ranged from low to some concern, primarily due to post hoc analyses, incomplete outcome data, and a lack of prespecified ethnicity-stratified outcomes, and limited confidence in the findings. Overall, the current evidence does not support major ethnicity-related differences in the pharmacological management of pediatric obesity, although the certainty of this evidence is low. Larger prospectively designed trials with prespecified ethnic subgroup analyses are urgently needed to establish equitable personalized approaches to pharmacotherapy for childhood obesity. (registration number: CRD42025117631).