Williams David M, Staff Matthew, Bain Stephen C, Min Thinzar
Department of Diabetes and Endocrinology, Singleton Hospital, Swansea Bay University Health Board, Swansea, UK.
Diabetes Research Group, Swansea University Medical School, Swansea University, Swansea, UK.
touchREV Endocrinol. 2022 Mar;18(1):43-48. doi: 10.17925/EE.2022.18.1.43. Epub 2022 Mar 18.
There is an increasing prevalence of obesity worldwide, associated with significant morbidity and mortality, which frequently reduces quality of life and life expectancy. Consequently, there is a substantial and growing personal and economic burden necessitating the development of more effective therapies for obesity. Glucagon-like peptide-1 receptor analogues (GLP-1RAs) are licensed for the treatment of type 2 diabetes (T2D), and there is substantial evidence that these drugs not only improve cardiovascular outcomes but also promote weight loss. More recent evidence supports the use of the GLP-1RAs liraglutide and semaglutide in people with obesity without T2D. This article discusses the results of the major cardiovascular outcome trials for GLP-1RAs in people with T2D, the SCALE Obesity and Prediabetes study (Effect of liraglutide on body weight in non-diabetic obese subjects or overweight subjects with co-morbidities: SCALE™ - Obesity and Pre-diabetes; ClinicalTrials.gov identifier: NCT01272219; investigating liraglutide) and the STEP studies (Semaglutide treatment effect in people with obesity; assorted studies; investigating subcutaneous semaglutide). We also highlight the importance of a cost-effective approach to obesity pharmacotherapy. Clinicians should consider the use of GLP-1RAs in people with obesity, especially those with T2D or other obesity-related diseases, such as hypertension and dyslipidaemia. Ongoing trials, as well as clinical and cost-effectiveness appraisals, are anticipated over the next 12 months, and their findings may change the current landscape of obesity pharmacotherapy.
全球肥胖症患病率不断上升，与显著的发病率和死亡率相关，这常常降低生活质量和预期寿命。因此，个人和经济负担巨大且不断增加，需要开发更有效的肥胖症治疗方法。胰高血糖素样肽-1受体类似物（GLP-1RAs）已被批准用于治疗2型糖尿病（T2D），有大量证据表明这些药物不仅能改善心血管结局，还能促进体重减轻。最近的证据支持在没有T2D的肥胖人群中使用GLP-1RAs利拉鲁肽和司美格鲁肽。本文讨论了GLP-1RAs在T2D患者中的主要心血管结局试验结果、SCALE肥胖与糖尿病前期研究（利拉鲁肽对非糖尿病肥胖受试者或伴有合并症的超重受试者体重的影响：SCALE™ - 肥胖与糖尿病前期；ClinicalTrials.gov标识符：NCT01272219；研究利拉鲁肽）以及STEP研究（司美格鲁肽对肥胖人群的治疗效果；各类研究；研究皮下注射司美格鲁肽）。我们还强调了采用具有成本效益的肥胖症药物治疗方法的重要性。临床医生应考虑在肥胖人群中使用GLP-1RAs治疗，尤其是那些患有T2D或其他与肥胖相关疾病（如高血压和血脂异常）的患者。预计在未来12个月内会有正在进行的试验以及临床和成本效益评估，其结果可能会改变当前肥胖症药物治疗的格局。
