Division of Public Health Sciences, Department of Epidemiology and Prevention, Wake Forest University School of Medicine, 1 Medical Center Blvd, Winston-Salem, NC, 27157, USA.
MGH Weight Center, Massachusetts General Hospital, Boston, MA, USA.
Adv Ther. 2021 Jun;38(6):2821-2839. doi: 10.1007/s12325-021-01710-0. Epub 2021 May 11.
Obesity is a chronic disease associated with many complications. Weight loss of 5-15% can improve many obesity-related complications. Despite the benefits of weight reduction, there are many challenges in losing weight and maintaining long-term weight loss. Pharmacotherapy can help people with obesity achieve and maintain their target weight loss, thereby reducing the risk of obesity-related complications. The prevalence of obesity in the USA has been increasing over the past few decades, and despite the availability of approved anti-obesity medications (AOMs), people with obesity may not be accessing or receiving treatment at levels consistent with the disease prevalence. Reasons for low levels of initiation and long-term use of AOMs may include reluctance of public health and medical organizations to recognize obesity as a disease, lack of reimbursement, provider inexperience, and misperceptions about the efficacy and safety of available treatments. This article aims to inform primary care providers about the mechanism of action of one class of AOMs, glucagon-like peptide 1 receptor agonists (GLP-1RAs), in weight loss and longer-term maintenance of weight loss, and the efficacy and safety of this treatment class. GLP-1RA therapy was initially developed to treat type 2 diabetes. Owing to their effectiveness in reducing body weight, once-daily subcutaneous administration of liraglutide 3.0 mg has been approved, and once-weekly subcutaneous administration of semaglutide 2.4 mg is being investigated in phase III trials, for obesity management. Considerations regarding adverse effects and contraindications for different drug classes are provided to help guide treatment decision-making when considering pharmacotherapy for weight management in patients with obesity.
肥胖是一种与多种并发症相关的慢性疾病。体重减轻 5-15%可以改善许多与肥胖相关的并发症。尽管减肥有好处,但减肥和维持长期减肥存在许多挑战。药物治疗可以帮助肥胖患者实现并维持其目标体重减轻,从而降低与肥胖相关的并发症的风险。过去几十年,美国肥胖症的患病率一直在上升,尽管有批准的抗肥胖药物(AOM),但肥胖患者可能无法获得或接受与疾病流行程度一致的治疗。AOM 起始和长期使用水平低的原因可能包括公共卫生和医疗机构不愿意将肥胖视为一种疾病、缺乏报销、提供者缺乏经验以及对现有治疗方法的疗效和安全性存在误解。本文旨在向初级保健提供者介绍一类 AOM(胰高血糖素样肽 1 受体激动剂 [GLP-1RAs])在减肥和长期维持体重减轻方面的作用机制,以及该治疗类别的疗效和安全性。GLP-1RA 治疗最初是为治疗 2 型糖尿病而开发的。由于其在减轻体重方面的有效性,每日一次皮下注射利拉鲁肽 3.0mg 已获得批准,每周一次皮下注射司美格鲁肽 2.4mg 正在进行 III 期临床试验,以用于肥胖症的管理。考虑到不同药物类别的不良反应和禁忌症,有助于在考虑肥胖患者的体重管理药物治疗时指导治疗决策。