Kolanowski J
Endocrine Unit, Catholic University of Louvain, Brussels, Belgium.
Drug Saf. 1999 Feb;20(2):119-31. doi: 10.2165/00002018-199920020-00003.
This review evaluates the benefits and potential health risks of the currently used drugs that are approved for the pharmacological treatment of obesity. Analysis of several long term clinical trials indicates that all of these drugs are efficient in reducing excess bodyweight, and that the majority of them allow the maintenance of the reduced bodyweight for at least 1 year. However, the loss of bodyweight attributable to these drugs is in general rather modest, approaching only 0.2 kg per week during the first 6 months of treatment, and at least a partial regain of bodyweight occurs when these drugs are used for periods longer than 1 year. All of these drugs induce several adverse effects. Although most of these adverse effects are mild and transient, the prolonged use of adrenergic or serotonergic anorectic drugs, or their use as combination treatment, may induce serious and potentially life-threatening complications, such as primary pulmonary hypertension or valvular heart disease. The adrenergic appetite-suppressing drugs are not recommended for the treatment of obesity, since their safety has never been evaluated in long term clinical trials, and because of their stimulatory effects on the cardiovascular and nervous systems. The serotonergic drugs, such as fenfluramine and dexfenfluramine, have been the most widely used during the past decade; however, both these compounds have recently been withdrawn from the market, since their use was associated with serious cardiovascular complications. The safety of the prolonged therapeutic use of newer compounds such as sibutramine and orlistat has not yet been demonstrated. Therefore, none of the currently available anti-obesity medications meets the criteria of an 'ideal anti-obesity drug' and, if prescribed, these medications should be used with caution and only under careful medical supervision. Since obesity is recognised as a chronic health-threatening condition, and since classical behavioural therapeutic approaches lack long term efficacy, there is clearly a need for an efficient pharmacological treatment offering an acceptable safety profile. Such a treatment is not available at present. Development of new agents and a more careful assessment of the safety of currently available drugs are needed.
本综述评估了目前已获批用于肥胖症药物治疗的药物的益处和潜在健康风险。多项长期临床试验分析表明，所有这些药物在减轻超重方面均有效，且大多数药物能使减轻的体重维持至少1年。然而，这些药物导致的体重减轻总体较为适度，在治疗的前6个月中每周仅接近0.2千克，且当这些药物使用超过1年时，体重至少会部分反弹。所有这些药物都会引发多种不良反应。尽管这些不良反应大多轻微且短暂，但长期使用肾上腺素能或血清素能食欲抑制药物，或联合使用这些药物，可能会引发严重且可能危及生命的并发症，如原发性肺动脉高压或瓣膜性心脏病。不推荐使用肾上腺素能食欲抑制药物治疗肥胖症，因为其安全性从未在长期临床试验中得到评估，且因其对心血管和神经系统有刺激作用。血清素能药物，如芬氟拉明和右芬氟拉明，在过去十年中使用最为广泛；然而，这两种化合物最近已退出市场，因为其使用与严重的心血管并发症有关。西布曲明和奥利司他等新型化合物长期治疗使用的安全性尚未得到证实。因此，目前可用的抗肥胖药物均不符合“理想抗肥胖药物”的标准，若开处方使用，这些药物应谨慎使用且仅在仔细的医疗监督下使用。由于肥胖被认为是一种慢性健康威胁状况，且由于传统行为治疗方法缺乏长期疗效，显然需要一种有效且安全性可接受的药物治疗方法。目前尚无此类治疗方法。需要开发新药物并更仔细地评估现有药物的安全性。
