Butsch W Scott
aDivision of Nutrition, Harvard Medical School bMassachusetts General Hospital Weight Center, Obesity Metabolism and Nutrition Institute, Massachusetts General Hospital, Boston, Massachusetts, USA.
Curr Opin Endocrinol Diabetes Obes. 2015 Oct;22(5):360-6. doi: 10.1097/MED.0000000000000192.
Lifestyle modification remains the mainstay of treatment for obesity despite the lack of substantial long-term efficacy. For many who do not respond to lifestyle therapy and are not candidates for weight loss surgery, pharmacotherapy is a viable treatment option. Advances in understanding mechanisms of appetite control, nutrient sensing, and energy expenditure have not only helped shape current drug development but have also changed the way in which antiobesity medications are prescribed. Current antiobesity medications and pharmacological strategies will be reviewed.
Two new antiobesity drugs - naltrexone/bupropion (Contrave) and liraglutide (Saxenda) - were approved by the US Food and Drug Administration in 2014 and join four other approved obesity medications, including phentermine/topiramate XR (Qsymia) and lorcaserin (Belviq), to form the largest number of medications available for the treatment of obesity. In addition, investigational drugs, like belnoranib, show promise in early clinical trials, brightening the outlook on drug development.
To combat the complex physiological system of energy regulation and the known variation of treatment response, combinatory therapies for obesity, including pharmacotherapy, are needed. Now six US Food and Drug Administration-approved antiobesity medications, including two combination medications, will allow providers to tailor obesity treatment in combination with lifestyle modification for a great number of individuals with obesity.
尽管缺乏显著的长期疗效，但生活方式改变仍是肥胖治疗的主要手段。对于许多对生活方式治疗无反应且不适合减肥手术的人来说，药物治疗是一种可行的治疗选择。对食欲控制、营养感知和能量消耗机制认识的进展不仅有助于塑造当前的药物研发，也改变了抗肥胖药物的处方方式。本文将对当前的抗肥胖药物和药理学策略进行综述。
两种新型抗肥胖药物——纳曲酮/安非他酮（Contrave）和利拉鲁肽（Saxenda）——于2014年获得美国食品药品监督管理局批准，加入了其他四种已获批的肥胖治疗药物，包括 phentermine/topiramate XR（Qsymia）和氯卡色林（Belviq），形成了可用于治疗肥胖的最多药物种类。此外，像贝利那尼这样的研究性药物在早期临床试验中显示出前景，为药物研发带来了希望。
为应对复杂的能量调节生理系统以及已知的治疗反应差异，需要包括药物治疗在内的肥胖联合治疗方法。现在有六种美国食品药品监督管理局批准的抗肥胖药物，包括两种复方药物，将使医疗服务提供者能够结合生活方式改变，为大量肥胖个体量身定制肥胖治疗方案。
