Garvey W Timothy
Department of Nutrition Sciences and the UAB Diabetes Research Center, University of Alabama at Birmingham, Birmingham, AL.
Diabetes Spectr. 2024 Nov 15;37(4):325-334. doi: 10.2337/dsi24-0004. eCollection 2024 Fall.
Semaglutide and tirzepatide have recently been approved for obesity and found to achieve ≥15% weight loss in clinical trials. These drugs have been referred to as second-generation medications because the unprecedented degree of weight loss they afford is sufficient to treat or prevent a broad array of obesity complications and related diseases. Many other medications are in development based on the actions of nutrient-regulated hormones (NRHs), including mono-, dual-, and triple-receptor agonists/antagonists for glucagon-like peptide 1, glucose-dependent insulinotropic polypeptide, amylin, peptide tyrosine-tyrosine, and glucagon. Clinical trial evidence is accumulating that these medications ameliorate multiple biomechanical, metabolic, and vascular complications of obesity. These tools enable a comprehensive complications-centric approach to care within the contextual framework of the diagnostic term adiposity-based chronic disease (ABCD). The potential to reduce patient suffering and the huge social burden of ABCD is profound. The current era of drug development based on NRHs could represent a landmark in the history of medicine provided that societies ensure access to these medications for the patients who need them.
司美格鲁肽和替尔泊肽最近已被批准用于治疗肥胖症，并且在临床试验中发现可实现≥15%的体重减轻。这些药物被称为第二代药物，因为它们前所未有的减重程度足以治疗或预防一系列广泛的肥胖并发症及相关疾病。基于营养调节激素（NRHs）的作用，许多其他药物正在研发中，包括胰高血糖素样肽1、葡萄糖依赖性促胰岛素多肽、胰淀素、肽YY和胰高血糖素的单受体、双受体和三受体激动剂/拮抗剂。越来越多的临床试验证据表明，这些药物可改善肥胖的多种生物力学、代谢和血管并发症。在基于肥胖的慢性疾病（ABCD）这一诊断术语的背景框架内，这些工具能够实现以并发症为中心的全面护理方法。减轻患者痛苦以及减轻ABCD带来的巨大社会负担的潜力是巨大的。倘若社会能够确保有需要的患者能够获得这些药物，那么当前基于NRHs的药物研发时代可能会成为医学史上的一个里程碑。
