Comparative effectiveness of Chinese herbal medicine versus liraglutide for weight loss in adults with obesity: A 12-month real-world target trial emulation study

Background Chinese herbal medicine (CHM) is commonly used for weight control in Taiwan. This study aimed to compare the effectiveness and mechanisms of a fixed combination of CHM with liraglutide using a target trial emulation real-world study. Methods From January 1, 2013, to December 31, 2018, subjects from the multi-institutional Chang Gung Research Database (CGRD) with a BMI ≥ 25 kg/m² received a fixed combination of Ma-Xing-Gan-Shi-Tang and Coptis chinensis Franch, namely Ma-Xing-Gan-Shi-Tang and Coptis chinensis Franch LOwering Weight formula (MCLOW), were compared with those using liraglutide for weight control for a 12-month follow-up course with overlap weighting for baseline inequality. Results Among 376 subjects, 135 (35.9%) used MCLOW, who lost more weight from baseline (-6.07 [95% CI: -6.90 to -5.24] vs. -1.66 [95% CI:-2.22 to -1.1] kg; p-value < 0.001), and had a higher proportion achieved weight reductions of ≥ 5% and ≥ 10% (68.15% vs. 23.65%, p < 0.001 and 32.59% vs. 7.05%, p-value < 0.001, respectively). The results were consistent with overlap and inverse probability of treatment weighting models. By using network pharmacology, use of MCLOW was associated with lipid metabolism and immune-related pathways, while liraglutide was linked to insulin-secretion pathways. Conclusion The CHM formula MCLOW appears to have promising effects on weight loss, with mechanisms differing from but complementary to those of Western medicines.