Morton John M, Shah Sajani N, Wolfe Bruce M, Apovian Caroline M, Miller Christopher J, Tweden Katherine S, Billington Charles J, Shikora Scott A
Stanford School of Medicine, Stanford, CA, USA.
Tufts Medical Center, Boston, MA, USA.
Obes Surg. 2016 May;26(5):983-9. doi: 10.1007/s11695-016-2143-y.
Vagal nerve blockade (vBloc) therapy was shown to be a safe and effective treatment for moderate to severe obesity. This report summarizes the safety and efficacy of vBloc therapy in the prespecified subgroup of patients with moderate obesity.
The ReCharge Trial is a double-blind, randomized controlled clinical trial of participants with body mass index (BMI) of 40-45 or 35-40 kg/m(2) with at least one obesity-related comorbid condition. Participants were randomized 2:1 to implantation with either a vBloc or sham device with weight management counseling. Eighty-four subjects had moderate obesity (BMI 35-40 kg/m(2)) at randomization.
Fifty-three participants were randomized to vBloc and 31 to sham. Qualifying obesity-related comorbidities included dyslipidemia (73%), hypertension (58%), sleep apnea (33%), and type 2 diabetes (8%). The vBloc group achieved a percentage excess weight loss (%EWL) of 33% (11% total weight loss (%TWL)) compared to 19% EWL (6% TWL) with sham at 12 months (treatment difference 14 percentage points, 95% CI, 7-22; p < 0.0001). Common adverse events of vBloc through 12 months were heartburn/dyspepsia and implant site pain; the majority of events were reported as mild or moderate.
vBloc therapy resulted in significantly greater weight loss than the sham control among participants with moderate obesity and comorbidities with a well-tolerated safety profile.
迷走神经阻断(vBloc)疗法已被证明是治疗中度至重度肥胖的一种安全有效的方法。本报告总结了vBloc疗法在中度肥胖患者预先指定亚组中的安全性和有效性。
ReCharge试验是一项双盲、随机对照临床试验,参与者的体重指数(BMI)为40 - 45或35 - 40 kg/m²,且至少有一种与肥胖相关的合并症。参与者按2:1随机分组,分别植入vBloc装置或假装置,并接受体重管理咨询。84名受试者在随机分组时患有中度肥胖(BMI 35 - 40 kg/m²)。
53名参与者被随机分配到vBloc组,31名被分配到假手术组。符合条件的与肥胖相关的合并症包括血脂异常(73%)、高血压(58%)、睡眠呼吸暂停(33%)和2型糖尿病(8%)。vBloc组在12个月时实现了33%的超重减轻百分比(%EWL)(总体重减轻(%TWL)为11%),而假手术组为19%的EWL(6% TWL)(治疗差异为14个百分点,95% CI,7 - 22;p < 0.0001)。vBloc组在12个月内常见的不良事件是烧心/消化不良和植入部位疼痛;大多数事件报告为轻度或中度。
在中度肥胖及合并症的参与者中,vBloc疗法导致的体重减轻明显大于假手术对照组,且安全性良好,耐受性佳。