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News of pharmacological treatment of obesity


Authors: Šrámková P.
Authors place of work: OB klinika, Praha
Published in the journal: Gastroent Hepatol 2018; 72(6): 495-500
Category:
doi: https://doi.org/10.14735/amgh2018495

Summary

Weight reduction can improve comorbidities and reduce risk factors in obese individuals and requires a comprehensive and individual approach. Pharmacother­apy of obesity is eligible to individuals who do not respond satisfyingly to changes in dietary and exercise regime. Pharmacother­apy is recom­mended for patients with body mass index (BMI) ≥ 27 and as­sociated comorbidities or with BMI ≥ 30. Exclud­­ing Orlistat, the ef­fect of antiobesitic medication is to reduce the food intake through changes in appetite and feel­­ing of hunger. Treatment can be continued if weight loss after 3 months is ≥ 5% of the individual’s original weight, without undesirable ef­fects. In the Czech Republic, obesity is treated with orlistat, limited prescription phentermine for short-term use, a new bupropion-naltrexone combination drug, and injectable liraglutide (available from November 2018) at a dosage of 3mg/d. GLP-1 analogues and SGLT-2 blockers are recom­mended for treatment of diabetes, along with their antidiabetic impact, they improve the blood glucose level and support weight los­s. There is a broader range of options in the USA. In addition to already mentioned medication there is lorcaserin, the combination of phentermine and bupropion, pramlintide and bromocriptine for patients with T2DM. Cur­rently available anti-obesity drugs lead to weight reductions averag­­ing 5–10% of the individual’s original weight per year. Orlistat has the smal­lest ef­fect (–2.9kg/year), but the least adverse ef­fects. The phentermine/topiramate combination has the greatest ef­fect (–10.2kg/year). The etiology of obesity combines genetic and environmental factors and influences the patient throughout his life. Alike other chronic dis­eases such as hypercholesterolaemia or hypertension, the obesity treatment is for lifelong. The short-term ther­apy results in the yo yo ef­fect. Contraindications should be respected when prescrib­­ing anti-obesity drugs, and obese individuals should be educated about the need to reduce food intake and increase physical activity.

Key words:

obesity – pharmacother­apy – orlistat – combination of bupropion and naltrexone – liraglutide

Submitted: 22. 9. 2018

Accepted: 10. 10. 2018

The author declares she has no potential conflicts of interest concerning drugs, products, or services used in the study.

The Editorial Board declares that the manuscript met the ICMJE „uniform requirements“ for bio­­­­medical papers.


Zdroje

1. Korner J, Liebel RL. To eat or not to eat – how the gut talks to the brain. N Engl J Med 2003; 349(10): 926–928. doi: 10.1056/NEJMp038114.

2. Kim GW, Lin JE, Blomain ES et al. Antiobesity pharmacother­apy: new drugs and emerg­­ing targets. Clin Pharmacol Ther 2014; 95(1): 53–66. doi: 10.1038/clpt.2013.204.

3. Hainer V et al. Základy klinické obezitologie. 2. vyd. Praha: Grada Publish­­ing 2011: 277–280.

4. JS Torgerson, Hauptman J, Boldrin MN et al. XENical in the prevention of diabetes in obese subjects (XENDOS) study: a randomized study of orlistat as an adjunct to lifestyle changes for the prevention of type 2 diabetes in obese patiens. Diabetes Care 2004; 27(1): 155–161.

5. Torgerson JS, Hauptman J, Boldrin MN et al. Xenical in the prevention of diabetes in obese subject (XENDOS) study: a randomized study of orlistat as an adjunct to lifestyle changes for prevention of type 2 diabetes in obese patients. Diabetes Care 2004; 27(1): 155–161.

6. Gadde KM, Al­lison DB, Ryan DH et al. Ef­fects of low-dose, control­led-release, phentermine plus topiramate combination on weight and as­sociated comorbidities in overweight and obese adults (CONQUER): a randomised, placebo-control­led, phase 3 trial. Lancet 2011; 16; 377(9774): 1341–1452. doi: 10.1016/S0140-6736(11)60205-5.

7. Smith SR, Weis­sman NJ, Anderson CM et al. Multicenter, placebo-control­led trial of lorcaserin for weight management. N Engl J Med 2010; 363(3): 245–256. doi: 10.1056/NEJMoa0909809.

8. Nigro SC, Luon D, Baker WL. Lorcaserin: a novel serotonin 2C agonist for the treatment of obesity. Curr Med Res Opin 2013; 29(7): 839–848. doi: 10.1185/03007995.2013.794776.

9. Bil­les SK, Sin­nayah P, Cowley MA. Naltrexone/bupropion for obesity: An investigational combination pharmacother­apy for weight los­s. Pharmacol Res 2014; 84: 1–11. doi: 10.1016/j.phrs.2014.04.004.

10. Waden TA, Foreyt JP, Foster GD et al. Weight loss with naltrexone SR/bupropion SR combination ther­apy as an adjunct to behavior modification: the COR-BMOD trial. Obesity (Silver Spring) 2011; 19(1): 110–120. doi: 10.1038/oby.2010.147.

11. Jels­­ing J, Vrang N, Raun K et al. Liraglutide induced anorexia is not mediated via brainstem GLP-1 neurons. Diabetes 2011; 60 (Suppl 1): A1083.

12. Flint A, Raben A, Ersbøll AK et al. The ef­fect of physiological levels of glucagon-like peptide-1 on appetite, gastric emptying, energy and substrate metabolism in obesity. Int J Obes Relat Metab Disord 2001; 25(6): 781–792. 10.1038/sj.ijo.0801627.

13. Deacon CF, Nauck MA, Toft-Nielsen M et al. Both subcutaneously and intravenously administered glucagon-like peptide 1 are rapidly degraded from the NH2-terminus in type II diabetic patients and in healthy subjects. Diabetes 1995; 44(9): 1126–1131.

14. Astrup A, Car­raro R, Finer N et al. Safety, tolerability and sustained weight loss over 2 years with the once-daily human GLP-1 analog, liraglutide. Int J Obes (Lond) 2012; 36(6): 843–854. doi: 10.1038/ijo.2011.158.

15. Pi-Sunyer X, Astrup A, Fujioka K et al. A randomized, control­led trial of 3.0mg of liraglutide in weight management. N Engl J Med 2015; 373(1): 11–22. doi: 10.1056/NEJMoa1411892.

16. Dunican KC, Adams NM, Desilets AR. The role of pramlintide for weight los­s. Ann Pharmacother 2010; 44(3): 538–545. doi: 10.1345/aph.1M210.

Štítky
Paediatric gastroenterology Gastroenterology and hepatology Surgery

Článok vyšiel v časopise

Gastroenterology and Hepatology

Číslo 6

2018 Číslo 6
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