Wen Jimmy, Nadora Denise, Bernstein Ethan, How-Volkman Christiane, Truong Alina, Akhtar Muzammil, Prakash Neha A, Puglisi Jose, Frezza Eldo
Physical Medicine and Rehabilitation, California Northstate University College of Medicine, Elk Grove, USA.
Neurology, California Northstate University College of Medicine, Elk Grove, USA.
Cureus. 2024 Sep 9;16(9):e69008. doi: 10.7759/cureus.69008. eCollection 2024 Sep.
Obesity places patients at higher risk for numerous problems, including prediabetes, type 2 diabetes mellitus (T2DM), hypertension, metabolic syndrome, cardiovascular disease, and nonalcoholic fatty liver disease. Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are antidiabetic drugs that have a recognized effect on weight loss. This systematic review analyzed semaglutide against alternative GLP-1 agonists in facilitating weight loss and evaluated their associated adverse events (AEs) in diabetic patients. A systematic search following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines was performed using PubMed, Embase, and Cochrane Library for studies comparing semaglutide and other GLP-1 RAs for weight loss. A narrative synthesis and meta-analysis using SPSS program version 29 were performed to analyze the differences in weight loss between cohorts. Nine studies with 5,445 patients whose mean age was 60.01 years (55.5-70) and mean follow-up of 32.5 weeks (4-58.7) were included. The meta-analysis showed that semaglutide had a greater mean weight loss compared to liraglutide (-6.08, 95% confidence interval (Cl) = -8.40, -3.75) and dulaglutide (-2.85, 95% CI = -5.59, 0.11). Tirzepatide had a greater mean weight loss compared to semaglutide (-3.78, 95% CI = -5.52, -2.04). Common AEs included minor and moderate gastrointestinal events. In conclusion, GLP-1 RAs have shown efficacy in reducing body weight in T2DM patients. Semaglutide, liraglutide, dulaglutide, tirzepatide, and exenatide demonstrated mean weight loss reductions of 4.81 kg, 2.81 kg, 4.03 kg, 9.7 kg, and 1.9 kg, respectively, with high rates of minimal to moderate-severity AEs. Semaglutide demonstrated increased numerical weight loss compared to its comparators (dulaglutide, liraglutide, and exenatide). However, tirzepatide, a dual-agonist, produced greater weight loss compared to semaglutide. The paucity of comparative head-to-head trials prevents a definitive conclusion of the superiority of one GLP-1 RA over another.
肥胖使患者面临众多问题的更高风险，包括糖尿病前期、2型糖尿病（T2DM）、高血压、代谢综合征、心血管疾病和非酒精性脂肪性肝病。胰高血糖素样肽-1受体激动剂（GLP-1 RAs）是一类抗糖尿病药物，对体重减轻有公认的作用。本系统评价分析了司美格鲁肽与其他GLP-1激动剂在促进体重减轻方面的效果，并评估了它们在糖尿病患者中的相关不良事件（AEs）。按照系统评价和Meta分析的首选报告项目（PRISMA）指南，在PubMed、Embase和Cochrane图书馆进行了系统检索，以查找比较司美格鲁肽和其他GLP-1 RAs用于体重减轻的研究。使用SPSS 29版程序进行叙述性综合分析和Meta分析，以分析各队列之间体重减轻的差异。纳入了9项研究，共5445例患者，平均年龄为60.01岁（55.5 - 70岁），平均随访32.5周（4 - 58.7周）。Meta分析表明，与利拉鲁肽相比，司美格鲁肽的平均体重减轻更多（-6.08，95%置信区间（Cl） = -8.40，-3.75），与度拉鲁肽相比也更多（-2.85，95% CI = -5.59，0.11）。与司美格鲁肽相比，替尔泊肽的平均体重减轻更多（-3.78，95% CI = -5.52，-2.04）。常见的不良事件包括轻度和中度胃肠道事件。总之，GLP-1 RAs已显示出在降低T2DM患者体重方面的疗效。司美格鲁肽、利拉鲁肽、度拉鲁肽、替尔泊肽和艾塞那肽的平均体重减轻分别为4.81 kg、2.81 kg、4.03 kg、9.7 kg和1.9 kg，轻度至中度严重程度不良事件的发生率较高。与对照药物（度拉鲁肽、利拉鲁肽和艾塞那肽）相比，司美格鲁肽在体重减轻数值上有所增加。然而，双靶点激动剂替尔泊肽比司美格鲁肽产生了更大的体重减轻。缺乏比较性的头对头试验，无法得出一种GLP-1 RA优于另一种的确切结论。
