Pujol Calafat Antelm, Nicolau Joana, Gil Apolonia, Blanco Anesto Jorge
Servicio de Endocrinología y Nutrición. Hospital Universitario de Son Llátzer.
Clínica Rotger (Grupo Quirón).
Nutr Hosp. 2024 Dec 19;41(6):1224-1230. doi: 10.20960/nh.05244.
Background: the prevalence of obesity is reaching a pandemic status. The SCALE trials showed that liraglutide 3 mg among people with obesity (PwO) was effective to reduce bodyweight and related complications. The fact that almost two-thirds of patients did not achieve the desired weight loss with the maximum dose of liraglutide made almost mandatory the development of other pharmacological options. The STEP 1-5 trials showed the effectiveness of semaglutide in reducing bodyweight in a dose-dependent manner. Moreover, the STEP 8 trial proved the superiority of semaglutide 2,4 mg/week versus liraglutide 3 mg/daily. We aimed to assess the effects of subcutaneous (s.c.) semaglutide 0.5 mg/weekly compared with s.c. liraglutide 3 mg/daily in PwO on anthropometric parameters in a real world-scenario for 3 months. Methods: we retrospectively evaluated 179 PwO (91.9 % ♀, 45.7 ± 10 years, and 33.3 ± 7 kg/m2) who received treatment with aGLP-1 as add-on therapy to lifestyle interventions. Patients were evaluated at baseline and after 3 months. Ninety-nine patients were prescribed s.c. semaglutide 0.5 mg/weekly with an off-label indication for weight reduction. These patients were compared with 80 patients treated with s.c. liraglutide 3 mg/daily. The main reason for prescribing of s.c. semaglutide was economic. Body composition was evaluated using a bioimpedance device (Tanita MC 580M®). Results: baseline weight was significantly greater with semaglutide compared to liraglutide (97.19 ± 21.09 vs. 90.73 ± 21.88 kg; p < 0.01) as was fat mass (42.43 ± 15.04 vs. 34.84 ± 16.07 kg; p < 0.01), whereas baseline lean mass was lesser among subjects treated with semaglutide (31.62 ± 7.56 vs 45.69 ± 15.51 kg; p < 0.01). PwO experienced a significant reduction in weight using s.c. semaglutide 0.5 mg/weekly (96.67 ± 20.83 vs. 91.44 ± 19.6 kg; p < 0.01) or s.c. liraglutide 3 mg/daily (90.73 ± 21.88 vs. 80.13 ± 18.38 kg; p < 0.01) No significant differences were seen between the amount of weight lost (5.28 ± 4.22 vs 5.72 ± 1.62 kg; p = 0.5) in the two groups. Furthermore, both groups were comparable in fat mass (2.69 ± 5.34 vs 0.96 ± 4.22 kg; p = 0.3) and fat-free mass (0.86 ± 1.63 vs 1.03 ± 0.94 kg; p = 0.07) after 3 months of treatment with both aGLP1. Side effects were gastrointestinal and transient/comparable between groups Conclusions: subcutaneous semaglutide 0.5 mg and subcutaneous liraglutide 3 mg are effective treatments for reducing weight safely among PwO in a real-world scenario at short term and without a negative impact on fat-free mass. Moreover, low doses of semaglutide were similar to liraglutide 3 mg in reducing bodyweight at short term.
肥胖的流行正达到大流行状态。SCALE试验表明，肥胖患者（PwO）使用3毫克利拉鲁肽可有效减轻体重及相关并发症。几乎三分之二的患者使用最大剂量利拉鲁肽未达到理想体重减轻效果，这使得开发其他药物选择几乎成为必然。STEP 1 - 5试验表明司美格鲁肽能以剂量依赖方式减轻体重。此外，STEP 8试验证明司美格鲁肽2.4毫克/周优于每日3毫克利拉鲁肽。我们旨在评估在现实场景中，每周皮下注射0.5毫克司美格鲁肽与每日皮下注射3毫克利拉鲁肽相比，对肥胖患者人体测量参数的影响，为期3个月。
我们回顾性评估了179例肥胖患者（女性占91.9%，年龄45.7±10岁，体重指数33.3±7千克/平方米），他们接受了胰高血糖素样肽-1（GLP - 1）作为生活方式干预附加疗法的治疗。在基线和3个月后对患者进行评估。99例患者被处方每周皮下注射0.5毫克司美格鲁肽，用于非标签减重适应证。将这些患者与80例每日皮下注射3毫克利拉鲁肽的患者进行比较。处方皮下注射司美格鲁肽的主要原因是经济因素。使用生物电阻抗装置（Tanita MC 580M®）评估身体成分。
与利拉鲁肽相比，司美格鲁肽组的基线体重（97.19±21.09千克对90.73±21.88千克；p<0.01）和脂肪量（42.43±15.04千克对34.84±16.07千克；p<0.01）显著更高，而司美格鲁肽治疗的受试者基线去脂体重较少（31.62±7.56千克对45.69±15.51千克；p<0.01）。肥胖患者使用每周皮下注射0.5毫克司美格鲁肽（96.67±20.83千克对91.44±19.6千克；p<0.01）或每日皮下注射3毫克利拉鲁肽（90.73±21.88千克对80.13±18.38千克；p<0.01）后体重均显著降低。两组体重减轻量无显著差异（5.28±4.22千克对5.72±1.62千克；p = 0.5）。此外，在两种GLP - 1治疗3个月后，两组的脂肪量（2.69±5.34千克对0.96±4.22千克；p = 0.3）和去脂体重（0.86±1.63千克对1.03±0.94千克；p = 0.07）具有可比性。副作用为胃肠道反应，且两组间短暂性/具有可比性。
在现实场景中，每周皮下注射0.5毫克司美格鲁肽和每日皮下注射3毫克利拉鲁肽是短期内安全减轻肥胖患者体重的有效治疗方法，且对去脂体重无负面影响。此外，短期内低剂量司美格鲁肽在减轻体重方面与3毫克利拉鲁肽相似。
