Boland Cassie L, Harris John Brock, Harris Kira B
Wingate University School of Pharmacy, Wingate, NC, USA
Wingate University School of Pharmacy, Wingate, NC, USA.
Ann Pharmacother. 2015 Feb;49(2):220-32. doi: 10.1177/1060028014557859. Epub 2014 Nov 3.
To review current evidence of pharmacological options for managing pediatric obesity and provide potential areas for future research.
A MEDLINE search (1966 to October 2014) was conducted using the following keywords: exenatide, liraglutide, lorcaserin, metformin, obesity, orlistat, pediatric, phentermine, pramlintide, topiramate, weight loss, and zonisamide.
Identified articles were evaluated for inclusion, with priority given to randomized controlled trials with orlistat, metformin, glucagon-like peptide-1 agonists, topiramate, and zonisamide in human subjects and articles written in English. References were also reviewed for additional trials.
Whereas lifestyle modification is considered first-line therapy for obese pediatric patients, severe obesity may benefit from pharmacotherapy. Orlistat is the only Food and Drug Administration (FDA)-approved medication for pediatric obesity and reduced body mass index (BMI) by 0.5 to 4 kg/m(2), but gastrointestinal (GI) adverse effects may limit use. Metformin has demonstrated BMI reductions of 0.17 to 1.8 kg/m(2), with mild GI adverse effects usually managed with dose titration. Exenatide reduced BMI by 1.1 to 1.7 kg/m(2) and was well-tolerated with mostly transient or mild GI adverse effects. Topiramate and zonisamide reduced weight when used in the treatment of epilepsy. Future studies should examine efficacy and safety of pharmacological agents in addition to lifestyle modifications for pediatric obesity.
Lifestyle interventions remain the treatment of choice in pediatric obesity, but concomitant pharmacotherapy may be beneficial in some patients. Orlistat should be considered as second-line therapy for pediatric obesity. Evidence suggests that other diabetes and antiepileptic medications may also provide weight-loss benefits, but safety should be further evaluated.
回顾当前用于治疗儿童肥胖症的药物选择证据，并提供未来研究的潜在领域。
使用以下关键词在MEDLINE数据库（1966年至2014年10月）中进行检索：艾塞那肽、利拉鲁肽、氯卡色林、二甲双胍、肥胖症、奥利司他、儿科、苯丁胺、普兰林肽、托吡酯、体重减轻和唑尼沙胺。
对检索到的文章进行纳入评估，优先选择在人类受试者中进行的关于奥利司他、二甲双胍、胰高血糖素样肽-1激动剂、托吡酯和唑尼沙胺的随机对照试验以及英文撰写的文章。还对参考文献进行回顾以查找其他试验。
虽然生活方式改变被认为是肥胖儿童患者的一线治疗方法，但严重肥胖可能从药物治疗中获益。奥利司他是唯一获得美国食品药品监督管理局（FDA）批准用于儿童肥胖症的药物，可使体重指数（BMI）降低0.5至4kg/m²，但胃肠道（GI）不良反应可能限制其使用。二甲双胍已证明可使BMI降低0.17至1.8kg/m²，轻度GI不良反应通常通过剂量滴定来控制。艾塞那肽使BMI降低1.1至1.7kg/m²，耐受性良好，主要为短暂或轻度GI不良反应。托吡酯和唑尼沙胺在用于治疗癫痫时可减轻体重。未来的研究除了生活方式改变外，还应研究药物制剂对儿童肥胖症的疗效和安全性。
生活方式干预仍然是儿童肥胖症的首选治疗方法，但在某些患者中联合药物治疗可能有益。奥利司他应被视为儿童肥胖症的二线治疗药物。有证据表明，其他糖尿病和抗癫痫药物也可能具有减肥益处，但安全性应进一步评估。
