Gadde Kishore M, Pritham Raj Y
Pennington Biomedical Research Center, Louisiana State University, 6400 Perkins Rd, Baton Rouge, LA, 70810, USA.
Department of Internal Medicine, Oregon Health & Science University, Portland, OR, 97239, USA.
Curr Diab Rep. 2017 May;17(5):34. doi: 10.1007/s11892-017-0859-2.
This review provides an overview of the current state of drug therapy for obesity, with a focus on four new drug therapies-lorcaserin, phentermine/topiramate, naltrexone/bupropion, and liraglutide 3.0 mg-which have been approved by the US Food and Drug Administration (FDA) for long-term management of obesity since 2012. Topics discussed in this paper include rationale for pharmacotherapy, history of antiobesity drugs, and efficacy and safety data from randomized controlled trials with implications for clinical practice.
Weight loss achieved by currently approved drugs ranges from approximately 3 to 9%, above and beyond weight loss with lifestyle counseling alone, after a year. Response and attrition rates in clinical trials indicate that the benefits of pharmacotherapy range from substantial for some patients, modest for others, and no benefits for others still. Decisions regarding selection of a suitable drug from the available pharmacotherapy options and duration of treatment should be based on the expected and observed benefit-to-risk balance and tailored to the needs of each individual patient using the principles of shared decision-making.
本综述概述了肥胖症药物治疗的现状，重点关注自2012年以来已获美国食品药品监督管理局（FDA）批准用于肥胖症长期管理的四种新型药物疗法——氯卡色林、苯丁胺/托吡酯、纳曲酮/安非他酮和3.0毫克利拉鲁肽。本文讨论的主题包括药物治疗的基本原理、减肥药的历史以及随机对照试验的疗效和安全性数据及其对临床实践的影响。
目前获批药物实现的体重减轻在一年后约为3%至9%，超过仅通过生活方式咨询实现的体重减轻。临床试验中的反应率和脱落率表明，药物治疗的益处对一些患者而言很大，对另一些患者而言适中，而对其他一些患者则没有益处。关于从可用药物治疗选项中选择合适药物以及治疗持续时间的决策应基于预期和观察到的效益风险平衡，并根据共同决策原则针对每个患者的需求进行调整。
