BE-LITE Medical Center, Fairfax, VA 22030, USA.
Am J Ther. 2010 Nov-Dec;17(6):596-603. doi: 10.1097/MJT.0b013e31818e30da.
The increasing prevalence of obesity in the United States is widely recognized as a complex problem with significant public health implications, morbidity, mortality, and costs. Pharmacotherapy can contribute to the treatment of obesity. The regulation of appetite and body weight involves multiple parallel neuronal and bodily mechanisms. Not surprisingly, experience has shown that a medication that targets any one mechanism produces weight loss of 5%-10%. Although weight loss of this magnitude may produce significant reductions in risk factors associated with cardiovascular morbidity and mortality, patients expect cosmetically meaningful reductions in weight (~20%-25%). Combining 2 medications that work via different mechanisms, that is, "combination pharmacotherapy," is an approach to obtaining cosmetically relevant reductions in weight. The most effective example of this approach was the combination of phentermine and fenfluramine. This article will describe a novel combination pharmacotherapy developed in clinical practice: the combination of phentermine with the serotonin precursor L-5-hydroxytryptophan plus the peripheral decarboxylase inhibitor, carbidopa. Observational data on the efficacy and safety of this combination pharmacotherapy will be presented. In conclusion, combination pharmacotherapy can make important contributions to the treatment of obesity. Controlled clinical trials should be done before such combination treatments are widely adopted.
美国肥胖症的发病率不断上升，这被广泛认为是一个具有重大公共卫生影响、发病率、死亡率和成本的复杂问题。药物治疗可以有助于肥胖症的治疗。食欲和体重的调节涉及多个平行的神经元和身体机制。毫不奇怪，经验表明，针对任何一种机制的药物只能产生 5%-10%的体重减轻。虽然这种程度的体重减轻可能会显著降低与心血管发病率和死亡率相关的风险因素，但患者期望体重有美容意义上的显著减轻（约 20%-25%）。通过不同机制作用的两种药物联合使用，即“联合药物治疗”，是获得美容相关体重减轻的一种方法。这种方法最有效的例子是苯丙胺和芬氟拉明的联合使用。本文将描述一种在临床实践中开发的新型联合药物治疗方法：将苯丙胺与 5-羟色氨酸前体 L-5-羟色氨酸和外周脱羧酶抑制剂卡比多巴联合使用。将介绍关于这种联合药物治疗的疗效和安全性的观察数据。总之，联合药物治疗可以为肥胖症的治疗做出重要贡献。在广泛采用这种联合治疗之前，应该进行对照临床试验。
