News of pharmacological treatment of obesity
Petra Šrámková1
+ Affiliation
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 3 mg/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 (–2.9 kg/year), but the least adverse effects. The phentermine/topiramate combination has the greatest effect (–10.2 kg/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.
Keywords
pharmacotherapy, combination of bupropion and naltrexone, liraglutide, obesity, orlistatTo read this article in full, please register for free on this website.
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Literature
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: 10.1185/03007995.2013.794 776.
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 3.0 mg 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.