*4.1.2 Liraglutide*

Liraglutide 3 mg is an FDA-approved injectable GLP-1 agonist. A gut-derived incretin hormone, it stimulates the GLP-1 receptor in the pancreatic islets, increases the delivery of insulin and lowers glucagon secretion [100]. It mediates WL through peripheral and CNS pathways, inhibits gastric emptying, promotes satiety and reduces hunger thereby decreasing food intake. The most common side effects encountered with liraglutide are nausea, vomiting, diarrhea, constipation and dyspepsia. These symptoms are usually mild and improve within days or weeks with continuation of treatment and gradual dose titration of the dose. WL with liraglutide may also increase the risk of symptomatic gallstones, and in rare cases may cause pancreatitis. Liraglutide is contraindicated in severe renal/hepatic insufficiency, pregnancy, history of pancreatitis or major psychiatric disorder [101]. In terms weight loss, liraglutide resulted in 5.4% weight loss at one year in large RCT [102]. A total 63.2% of the participants in the liraglutide group lost at least 5% of their weight compared with 27.1% in the placebo group (P<0.001)[102]. Likewise, 33.1% of liraglutide group lost more than 10% of their body weight versus 10.6% in the control group(P<0.001) [102]. Moreover, cardiometabolic risk, inflammatory markers, glycaemic parameters, blood pressure and lipids also improved [102]. For weight maintenance, the SCALE study found that among individuals who lost 5% of their initial body weight on a low-calorie diet, liraglutide added another 6.2% TWL% vs. 0.2% in the placebo group [103].
