Leslie W S, Hankey C R, Lean M E J
Human Nutrition, Division of Developmental Medicine, University of Glasgow, Queen Elizabeth Building, Glasgow Royal Infirmary, Glasgow, UK.
QJM. 2007 Jul;100(7):395-404. doi: 10.1093/qjmed/hcm044. Epub 2007 Jun 12.
Several drugs, or categories of drugs, listed by the WHO and other writers and used in the treatment of chronic disease, are consistently associated with weight gain as a side effect and considered 'obesogenic'. The extent to which they may contribute to the multifactorial process behind obesity is not well documented. We systematically reviewed papers from Medline 1966-2004, Embase 1980-2004, PsycINFO 1967-2004, and Cochrane Register of Controlled Trials, to determine the effect on body weight of some drugs that are believed to favour weight gain. We included randomized controlled studies of adult participants (>18 years) prescribed a drug considered obesogenic, that compared the 'obesogenic' drug with placebo, an alternative drug or other treatment, and that had a duration of at least 3 months: 43 studies totalling 25,663 subjects met these criteria. The main objective of the majority of studies was to compare the efficacy and safety of drug therapy, with weight change recorded under safety outcomes; weight change was a primary outcome measure in only six studies. There was evidence of weight gain for all drugs included, up to 10 kg at 52 weeks. Differences in dosage, patient population, duration of treatment and dietary advice make generalization of the results difficult. Data on body weight are often not recorded in published clinical trials or is reported in insufficient detail. This side-effect has potentially serious consequences, and should be mentioned to patients. Weight management measures should be routinely considered when prescribing drugs known to promote weight gain. Future clinical trials should always document weight changes.
世界卫生组织及其他作者列出的、用于治疗慢性病的几种药物或几类药物，一直以来都与体重增加这一侧效应相关，并被视为“致肥胖的”。它们在多大程度上可能促成肥胖背后的多因素过程，目前尚无充分的文献记载。我们系统回顾了1966年至2004年期间Medline、1980年至2004年期间Embase、1967年至2004年期间PsycINFO以及Cochrane对照试验注册库中的论文，以确定某些被认为会导致体重增加的药物对体重的影响。我们纳入了针对成年参与者（年龄>18岁）的随机对照研究，这些参与者被开具了一种被视为致肥胖的药物，该研究将“致肥胖”药物与安慰剂、另一种药物或其他治疗方法进行了比较，且研究持续时间至少为3个月：共有43项研究、总计25663名受试者符合这些标准。大多数研究的主要目的是比较药物治疗的疗效和安全性，体重变化记录在安全性结果之下；体重变化仅在六项研究中作为主要结果指标。有证据表明，所有纳入研究的药物都会导致体重增加，在52周时体重增加可达10千克。剂量、患者群体、治疗持续时间和饮食建议方面的差异使得结果难以一概而论。已发表的临床试验中通常未记录体重数据，或者记录不够详细。这种副作用可能会产生严重后果，应该告知患者。在开具已知会促进体重增加的药物时，应常规考虑体重管理措施。未来的临床试验应始终记录体重变化情况。
